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The SMW Program is designed for Medicaid eligible, Pennsylvania residents who are elderly and / or disabled. Services are provided on the Cash and Counseling model in which the participating individual self-directs their care by choosing their own care providers instead of the state agency making those decisions on their behalf. This model is also referred to as consumer-direction or participant direction. The SMW Program is not a Medicaid waiver per se, but rather is a way that waiver participants can receive services.
Participants work with a Case Manager from the state to collaboratively determine their needs and a budget for care services and goods. This is referred to as their 'Individual Service Plan.' Participants then determine when, where and from whom to purchase the necessary goods and services.
Neighbors, friends and even certain family members and relatives can be hired as paid caregivers; this includes the adult children of the participating elders, but not spouses or legal guardians. This optional way to receive services at home can be particularly helpful when the care recipient’s first language is something other than English.
The Services My Way Program makes use of a fiscal intermediary also referred to as an Employer Agent that is responsible for making payments to the care providers that are approved by the program participant.
To qualify for the SMW Program, PA residents must be qualified for either the PA Department of Aging Waiver (for persons aged 60 and over) or the Attendant Care Program (for persons aged 18-59), both of which are Medicaid programs. The non-financial requirements for these programs assert that the individual must require nursing home level care. The financial requirements are age and marital status dependent.
2018 PA Medicaid Waiver Income Limits
A single or widowed individual aged 65 and older is permitted up to $2,250 per month in income. Individual with income in access of that amount may still qualify either through a Medicaid Spend Down program or by working with a Medicaid planner to re-direct excess income into a pooled income trust. Married couples with a single applicant can re-direct joint income to the non-applicant to lower the applicant's income. This is especially relevant for older couples in which one spouse receives the vast majority of their income in his or her name.
2018 PA Medicaid Waiver Assets Limits
When using Services My Way option with PDA Waiver, the countable asset limit for an individual is effectively $8,000. In the situation of a married couple with one spouse not applying for Medicaid, that spouse can have up to $123,600 in countable resources.
It is important to note what is and is not considered "countable." The primary vehicle is exempt as well as funeral trusts and burial plans. The home is also exempt provided it is lived in by the owner(s). It cannot be a rental property. Also, important, the value of the applicant's home equity cannot be greater than $572,000.
When reviewing an applicant's financial status, state officials may look at the individual's asset transfers as far as five (5) years in the past. If one has any uncertainty regarding their Medicaid eligibility, a Medicaid planning professional can make the process of enrollment a lot easier. A rejected or incorrect application could significantly delay benefits. Learn more.
A wide range of services and goods are covered by the SMW Program. The specific benefits for which a participant is eligible are determined with their case manager in their Individual Service Plan and may include any of the following. Not all services can be self-directed.
The Services My Way Program is available statewide in all PA counties. Residents with questions about how this program works should check with the PA Long Term Care Helpline at 1-866-286-3636.
One can begin the application process by calling the PA Office of Long Term Care Helpline at 1-866-286-3636 or by contacting your Area Agency on Aging. Alternatively, some limited information is available on the Services My Way webpage.