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The Minnesota Medicaid Personal Care Assistance Service is not a program per se, but rather a different way to receive aging social services. Participants hire a Personal Care Assistant (PCA) who helps them to manage their Activities and Instrumental Activities of Daily Living, such as bathing, eating and basic mobility. The funds to pay for the PCA come from the different health service groups.
Participants have the option to self-direct their personal care service, which offers a great deal of flexibility regarding whom persons are able to hire to help with their activities of daily living. Friends, neighbors, and even some family members can be employed as the Personal Care Assistant or, essentially, a caregiver. While adult children can be compensated as personal care assistants for the participating elders, the spouses and legal guardians are barred from being paid for this role.
This concept is based on the Cash and Counseling Model, where individuals are provided with access to cash and they receive the counseling they require to arrange their own care services. By transferring the administration of care services to the individual, the state saves money on administration costs and the individual gains flexibility and control.
It should be noted that Cash and Counseling—in more modern language—is called consumer or participant direction. One might also hear the PCA Program referred to as a PAS (Personal Assistance Service) Program and PCA Choice Option.
To be eligible for a Personal Care Assistant, one must participate in one of the following four programs:
1) Minnesota Medicaid (also known as Medical Assistance)
2) Elderly Waiver
3) Minnesota Alternative Care
4) Minnesota Managed Care program, such as Minnesota Senior Health Options (MSHO)
These programs all generally require that the individual have a low annual income, limited resources, and be at least 65 years old or disabled. However income and asset limits vary by program and marital status. For instance, as of 2018, in order for a senior to be eligible for Minnesota’s state Medicaid program under the Elderly, Blind, Disabled pathway, a single applicant must have monthly income less that $1,005, and assets under $3,000. For married applicants (both spouses applying), the income limit is $1,354 per month and the asset limit set at $6,000. For the Elderly Waiver, the income limit is significantly higher, and is set at $2,250 per month for a single applicant, and the asset limit is $3,000. Married applicants (again, both spouses applying), are allowed up to $2,250 / month per spouse, as each spouse is considered as an individual applicant. However, assets are considered jointly owned in this scenario, and the couple is able to retain up to $6,000 in assets.
In addition, participants must be assessed by a social worker with the county department of health to have a medical need for personal care assistance.
Individuals who are over the income limit should not be discouraged. Those with high medical bills in relation to their income may qualify through the Medically Needy pathway for Medical Assistance. This is often referred to as a “Spend-Down” Program, and the “spend-down” amount thought of as a deductible. However, if one is over the income limit, it is advisable to seek the advice of a Professional Medicaid Planner prior to filing a Medicaid application.
Due to the variety of providers and choices, getting started with PCA Choice is somewhat complicated. The easiest way to do so is by contacting your county health office to schedule a care needs assessment. A complete list of county contacts, office locations, and telephone numbers is available here.
Complete information about the program is also available in the Personal Care Assistance Program Manual. One can also find information about this program on Minnesota’s Department of Human Services website.