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Consumer Directed Attendant Services (CDAS) is a Medicaid entitlement program though Maine’s state Medicaid program. (Medicaid in Maine is more commonly referred to as MaineCare). CDAS covers personal or attendant care provided to Medicaid recipients in their homes or certain group living environments, as long as personal care services are not already provided. Under this program, program participants are empowered to select, hire, train, and manage their own care providers instead of having the state administrators select caregivers on their behalf. This consumer directed model of care is also referred to as participant direction, self-direction, and cash and counseling. To avoid confusion, it is worth mentioning that these services are also referred to as personal care attendant (PCA) services, or simply attendant services.
It is the intention of this program to help individuals remain living in their homes by providing care services in that environment instead of requiring individuals to move into nursing home residences. As mentioned previously, consumers are able to select their own personal care providers, with certain family members being among those who are eligible to be paid caregivers. In the past, parents and spouses have not been able to be hired, but the adult children (of aging parents) could become paid caregivers provided they were not also the legal representative of their parent. However, a bill has been introduced that will allow any relative to be hired to provide care services, including spouses and legal guardians. Unfortunately, at the time of this writing, it is unclear as to whether this bill has been enacted.
To be eligible for the MaineCare CDAS program, participants must be at least 18 years of age and have a permanent and verifiable disability that limits their ability to care for themselves and manage their activities of daily living. Individuals cannot reside in a hospital, nursing home, intermediate care facility or other private, non-medical, residential care facility, commonly called assisted living or board and care homes. They also cannot concurrently be receiving care services from other MaineCare programs in which personal care is offered. Finally, they must be financially eligible for MaineCare. Financial eligibility looks at both an applicant’s income and their “countable assets”.
Income Eligibility – Single senior applicants are subjected to a monthly income limit or $1,005 as of January 2018. This amount is equivalent to 100% of the Federal Poverty Level. Married applicants, if one spouse does not require MaineCare, are subjected to different criteria. The applicant has the same income limit, but the non-applicant spouse is permitted a Monthly Maintenance Needs Allowance of up to $3,090 by the applicant spouse.
Countable Asset Eligibility – The effective asset limit for a single person is $10,000 in cash and savings. Countable assets do not include one’s home if the value of their home equity is not greater than $858,000. Also exempt are personal items, furniture and two cars. Assets are considered jointly owned by married couples. However, up to $123,600 in assets can be allocated to the non-applicant spouse. This is referred to as the Community Spouse Resource Allowance. A “community spouse” is the non-applying spouse. Other strategies exist to help families meet the asset requirements.
Outside the above financial criteria, Maine also offers an alternative pathway to eligibility for “medically needy” persons. Medically Needy individuals have unusually high medical expenses, which they cannot afford to pay even though they have income over the limits mentioned above. This is a determination made by the state. It may be advantageous to consult with a private Medicaid expert prior to pursuing this approach. Learn more.
The exact services provided under the CDAS program are specific to the participating individual and are determined during enrollment in the program. They are re-assessed periodically to ensure their needs are continuing to be met. Participants can qualify for three different tiers of Personal Care Services (PCS) up to a maximum of 28 hours / week. PCS can include any or all of the following:
Personal care can be provided to individuals residing at home, in the homes of their loved ones.
The CDAS Program is run by the Maine Department of Health and Human Services; one should contact their local office. A list of offices and their contact information is available here. One can also read more about the program in the very comprehensive MaineCare benefits manual available here.