The Arkansas Independent Choices (IC) program is a member-directed option for seniors and disabled adults that follows the Cash and Counseling model. This means that the program grants qualifying state residents a monthly cash allowance to spend on their care. The program staff also provides counseling should the recipient or their legal representative need further guidance on how to make use of the funds. Typically, program participants elect to spend the funds on their personal care at home. Also sometimes called self-directed, consumer directed, or participant directed, the program allows those, who are able, to reside outside of nursing homes.
Family members can be hired and paid to provide personal care services.
An element of the Independent Choices program that makes it particularly attractive to many individuals is that certain relatives can be hired and paid to provide personal care services. While one’s spouse and legal guardian cannot be hired, other family members, including the adult children of aging parents, can be paid for providing care. Medicaid regulates the hourly rate in which these caregivers are paid.
According to Genworth’s Cost of Care Survey 2020, the average rate for home care in Arkansas (as of 2021) is $20.00 / hr. However, at the time of this writing, the Medicaid payment rate is the state’s minimum wage. In 2021, minimum wage in Arkansas is $11 / hr.
Independent Choices is not a Medicaid program. It is an option on how to receive personal assistance services / attendant care services under the Arkansas’ State Medicaid Personal Care Program and the ARChoices in Homecare Medicaid Waiver. This program is managed by the Arkansas Department of Human Services’ (DHS) Division of Aging and Adult Services (DAAS).
To be eligible, one must be at least 18 years old, have a medical need for personal care services, require assistance with his/her activities of daily living, and legally reside in the state of Arkansas. Most importantly, the candidate must be financially eligible for a Medicaid program in the state of Arkansas that provides personal care services.
Financial eligibility for Medicaid is a complex subject and the details depend on the personal situation of the applicant. For example, pregnant women have different requirements than do children, seniors, or young families. For the purposes of this page, two such programs are relevant for seniors and persons with disabilities: The Personal Care Program via the Arkansas state Medicaid plan and the ARChoices in Homecare Medicaid Waiver. Financial requirements for the Personal Care Program and ARChoices Waiver differ.
In 2021, in order for a single, divorced, widowed, or otherwise unmarried applicant to be financially eligible for the Personal Care Program, one must have monthly income less than $794 (100% of the Federal Benefit Rate). For married couples, their income must be no greater than $1,191 / month. Both spouses’ income is considered in the eligibility process, regardless of if one, or both spouses, are applicants.
For the ARChoices Medicaid Waiver, a single applicant is permitted up to $2,382 per month in income. For married couples, with both spouses as applicants, the income limit remains the same as for single applicants; $2,382 / month per applicant. If just one spouse of a married couple is applying for this program, only the income of the applicant spouse is considered. Stated differently, the income of the non-applicant spouse has no impact on his/her spouse’s eligibility when it comes to the income limit. However, non-applicant spouses may be entitled to a portion of their applicant spouses’ income. This is called a monthly maintenance needs allowance. As of 2021, this income allowance could be as much as $3,259.50 / month.
There are two types of assets. Those that Medicaid counts towards the asset limit and those that are not counted. Included in the latter are one’s home (if a non-applicant spouse does not reside in the home, the applicant’s equity interest must be no more than $603,000), household furnishings, a primary vehicle, and other personal items. Savings, stocks, bonds, second homes, and other property that can be converted to cash are all “countable assets”.
Single applicants have a countable asset limit of $2,000, and married applicants can have assets up to $3,000. The asset limit remains the same for a married couple regardless of if one or both spouses are applying for benefits. Please note that the assets of a married couple are considered jointly owned.
Single applicants have a countable asset limit of $2,000, and married applicants can have assets up to $3,000. Married couples, in which only one spouse is applying for services, are permitted a much higher asset limit. Assets are considered jointly owned for Medicaid eligibility, even if only one spouse is applying for benefits. In 2021, non-applicant spouses are allowed to keep up to $130,380 of the couples assets. This is called a community spouse resource allowance. Learn more about Medicaid and jointly owned assets here.
There are three categories of personal care related expenses that are paid for by the Independent Choices program.
1) Personal Assistance Services / Respite Personal Assistance Services – any assistance provided by a person that helps the program participant to accomplish their activities of daily living, such as bathing, dressing, toiletry, mobility, eating, and personal hygiene.
2) Products and Services that Increase Independence – these are goods and services that contribute towards decreasing the program participant’s reliance on other persons. This can include remote controls for operating lighting or household appliances, as well as technology-enabled services, such as personal emergency response and remote monitoring. Items to improve the health of the eligible individual, such as nutritional supplements and medications not covered by Medicaid, may also be purchased via the monthly allowance allotted by this program.
3) Home Modifications and Assistive Technologies – participants can save their monthly compensation to put towards the purchase of higher cost items or services, such as wheelchair ramps, stair-glides, walk-in tubs, and other modifications that increase their ability to live independently.
Families should contact the Independent Choices program directly at 888-682-0044 for more information and / or to apply. One can also download an Independent Choices manual here for additional information. Interested parties who are already eligible for Medicaid should call Palco at 1-866-710-0456 for a program pre-screening.
Those persons who are not yet on Medicaid, must first apply for the program. Information about the application process can be found here. Again, it is emphasized that it is recommended that persons who are unsure if they are eligible consult with a Medicaid planner before application.