Oklahoma Personal Care Program (Medicaid State Plan)

Program Description

The Oklahoma Personal Care program provides disabled and elderly residents with the funds to retain a personal care assistant to help them manage their Activities of Daily Living (ADLs) in their home or a family members home. Assistance with ADLs includes helping an eligible applicant dress, use the bathroom, eat, and so forth. This is a Medicaid program that is also referred to by the name of State Plan Personal Care.

This program is based on the Medicaid Cash and Counseling model, in which the consumer is empowered to self-direct their personal care by choosing whom is hired. Personal Care Program participants can select home care agencies, neighbors, friends, and even some non-immediate family members to provide them with personal care. To clarify, under this program certain family members are eligible to be paid caregivers; spouses and legal guardians are not eligible.

The Oklahoma Personal Care Program is an entitlement program. This means that anyone who is eligible to receive services via this program is able to do so, as there are no enrollment caps.

Oklahoma Medicaid, also called SoonerCare, offers a similar program with Consumer Direction that covers a broader range of services called the ADvantage Waiver.

 

Eligibility Guidelines

To be eligible for this program, all applicants must be residents of Oklahoma. There are also health and financial requirements in order to be eligible for the Personal Care Program. Applicants must require assistance to complete their activities of daily living. However, their disabilities cannot be so severe that they require skilled nursing level assistance or the level of care provided in an Intermediate Care Facility.

Financially, applicants must qualify for Medicaid. Oklahoma’s Medicaid is “means tested” which is to say, there are limits on both the applicant’s monthly income and their countable assets. These limits change depending on the person’s constituent group. For example, children, pregnant women and aged, blind or disabled persons all have different numerical limits.

Oklahoma Medicaid 2018 Income Limit for Seniors
To receive assistance from the Personal Care Program, individuals must be eligible for general Medicaid (as opposed to institutional Medicaid).

Seniors (65+) in 2018 are eligible if their monthly countable income is no greater than $791 (annually $9,492). Married applicants where one spouse is not applying should not have countable income more than $1,166 (annually $13,992). When both spouses are applying for Medicaid, their joint countable monthly income shall not exceed $1,207 (annually $14,484). Countable income allows for the deduction of some medical expenses, such as the cost of health insurance premiums.

Oklahoma Medicaid 2018 Assets Limit for Seniors
Single applicants are limited to $2,000 worth of countable assets and couples must have joint funds less than $3,000. The family home, provided it is lived in by at least one spouse, and valued at or under $572,000, is considered exempt. A vehicle, provided it is a utility vehicle, as opposed to a collector's car or an investment, is also exempt. Household items, personal goods, and burial plots are additional exempt assets. In addition, there are various other assets that can be considered exempt.

Persons over the income or asset limits who cannot afford their cost of care should consider a home and community based Medicaid waiver or institutional (nursing home) Medicaid, as the income limit is higher. A Medicaid planning expert can assist in identifying the best options and helping families to execute a strategy to become Medicaid compliant. Learn more.

 

Benefits and Services

The Personal Care Program pays for a personal assistant to help individuals with their activities of daily living, such as bathing, grooming, eating, mobility, and toileting. In addition, Instrumental Activities of Daily Living (IADLs) are additional benefits a participant may receive. These include assistance with meal preparation, laundry, housekeeping, and shopping for groceries and other essentials.

 

How to Apply / Learn More

This program is managed at the county level by the Oklahoma Department of Human Services office. One can find more information on their webpage or by calling their toll-free number at 1-800-435-4711.