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Based on the Cash and Counseling model, the Personal Choices program offers qualified, Alabama seniors and disabled individuals the option to select and manage their own care providers. This consumer directed program is open to Medicaid participants who are currently receiving services under the State of Alabama Independent Program (SAIL), previously referred to as the Homebound Waiver, and the Elderly and Disabled Waiver (E & D).
The Personal Choices program shifts the responsibility for selecting the caregiver provided under the Medicaid waivers to the participants themselves and allows them to direct their own care services. To be clear, wages for caregiving services are not made directly to the participants, but rather to an intermediary financial management agency, and then to care providers of the participants choosing. Participating individuals no longer receive care from Medicaid.
This type of program, in which the consumer directs their own care, is referred to by many names, including participant direction, self-directed care, and cash and counseling, as mentioned previously. Nationally, these programs are growing in popularity in part because they allow eligible individuals to be hands-on when it comes to the care they receive, and studies have shown that they may have positive effects on health outcomes. Seniors have a choice as to what provider they prefer, what type of care they need, and when the care is needed. An individual may have someone represent him or her to help manage care if he or she is not comfortable or capable of doing so alone. This program may also allow certain family members, with the exception of spouses, to be paid as personal care givers, as long as they are over 18 years of age and pass a basic screening test.
This program is governed by the Alabama Medicaid Agency in collaboration with the Alabama Department of Rehabilitation Services and the Alabama Department of Senior Services.
To qualify for the Personal Choices program, individuals must enroll (or be enrolled) in Medicaid and be receiving personal care or personal assistance services under the SAIL Waiver or the E & D Waiver. Under the rules for these waivers, a medical declaration is required that shows the client requires nursing home level care. In addition, there are certain financial requirements.
Income Limits – These limits change each year with the federal cost of living adjustment. In 2018, individual gross income cannot exceed $2,250 per month. For married couples in which both spouses are applying for services, monthly income is limited to $3,375. Individuals and couples who are over this income level have the option to use a Miller Trust to reduce income to within the limit and qualify. Money from the Miller Trust is commonly used to help cover medical and care costs of the Medicaid applicant.
Asset Limits - These limits typically do not change as frequently as the income limit. For the last few years, the limit for a single applicant has been $2,000, and has been $3,000 for a married couple in which both spouses are applying for Medicaid. Fortunately, Alabama permits non-applying spouses to retain some of the couple’s net worth and property. The couple’s primary residence, valued up to $572,000, their auto, household items, and personal effects are not counted towards eligibility purposes. In addition, the healthier, non-applicant spouse may be able to keep up to $123,600 of their savings and retirement accounts.
Past Asset Transfer Considerations – Importantly, the state may review an applicant's financial transfers as far back as 60 months before their application date to verify they did not try to give away money just to qualify for Medicaid. This is called the Medicaid Look-Back Period and may result in a period of ineligibility if one is found to be in violation.
Exceeding the limits by relatively minor amounts may not rule out qualifying. Planning professionals who specialize in Alabama Medicaid eligibility can help families to reach the state standards by shifting assets and using specially designed trusts. Learn more about how a Medicaid planner may assist.
The program pays cash to a Financial Management Service Agency in place of providing services. The Service Agency compensates care providers as determined by an agreed upon plan between the participant and their Personal Choice Program Counselor. Plans can include the following types of care:
It is also possible to save budgeted money on a monthly basis to go towards purchasing equipment, such as a lift chair, that is not available through Medicaid.
When this option was first introduced in 2007, the state designated it as a pilot program and it was only available in nine western counties. However, in October of 2015, it became available statewide. Individuals who are interested in using this option when they receive their waiver funded services should contact their local Area Agency on Aging in their region. More information about the program is available on the Alabama Personal Choices webpage.