Page Reviewed / Updated - May 20, 2019
For Connecticut residents who need help completing their activities of daily living, state Medicaid officials created the Personal Care Assistance (PCA) Program which is also referred to as the PCA Waiver. PCA pays for the cost of a personal care attendant to assist the participant with their activities of daily living as well as provides for adult day care and medical alert services.
This program was originally modeled on the national Cash and Counseling framework, allowing program participants to elect which service providers and personal caregivers to use. Spouses and Powers of Attorney are barred from being hired as paid caregivers through this program, but other family members may be hired. PCA is an optional program that can be added to various waiver services, including the Connecticut Home Care Program for the Elders.
With the introduction of Medicaid's Community First Choice (CFC) option in Connecticut, most persons who are using the PCA program are automatically moved to the CFC program. The advantage is that the CFC option does not have waiting lists for services, as are common for this program.
The PCA program serves both the aged 65 and over and individuals aged 18 – 64, who have a recognized disability. In addition to the age requirement, applicants must be residents of Connecticut who need hands-on assistance with at least two of their activities of daily living, such as bathing, eating, meal preparation, and administration of prescription drugs.
Applicants also must be financially eligible for Connecticut Medicaid. While Connecticut allows seniors to become Medicaid eligible by meeting different sets of requirements (referred to as “pathways”), most commonly, residents must meet the financial criteria that follows for the year 2019.
CT Personal Care Income Limits - single applicants are not permitted to have more than $2,313 in monthly income. Married individuals can exceed that limit provided their spouse is not also applying for Medicaid. Under this scenario, income up to $3,160.50 /month can be allocated to the spouse. This is called a monthly maintenance needs allowance and is in place to ensure the non-applicant spouse has sufficient funds from which to live.
CT Personal Care Asset Limits - single applicants can have up to $1,600 in countable resources. An owner-occupied home (limited to $858,000 in equity value), a primary vehicle and some personal effects are not considered as countable assets. However, all savings, stocks and additional property are counted as assets. In the situation where a spouse is not applying for Medicaid, that spouse is permitted to retain joint assets valued up to $126,420. This is called the community spouse resource allowance. Like with the income allowance, the resource allowance is intended to prevent spousal impoverishment.
Persons who cannot afford their cost of care, but are over Medicaid's limits may still qualify through the Medically Needy pathway. The state has a program that evaluates the individual's care costs and their income. If it is calculated they cannot meet their care costs, they can qualify for Medicaid provided they spend-down the income over the limit on their medically necessary care costs.
Personal caregivers can aid participants with their bathing, dressing, and hygiene, among other routine tasks. In addition to personal care services to help participants with their activities of daily living, the PCA program pays for subscriptions to Personal Emergency Response services, meal preparation and clean up, access to adult day care programs, modifications to their living quarters, assistive equipment, and wellness coaching.
Personal care attendants can be hired at the discretion of the program beneficiary. Phrased another way, program participants can choose and hire their own caregivers who will be paid by the program through a fiscal intermediary. Certain family members can be hired and paid as caregivers. As of April 2019, consumer directed personal care assistants are paid a minimum of $15.25 / hour. This figure will increase to $15.50 / hour in July 2019, $15.85 / hour in January 2020, and $16.25 / hour in July 2020.
A recent change to this program is an added benefit called Adult Family Living which we have written about extensively here.
More information about the PCA program can be found here or by downloading the Waiver Application. Be aware that the latter is not intended for consumers, but still provides extensive details about the program.
Interested applicants can call the state Department of Social Services at 1-800-445-5394. Persons can also go the Department’s website to check their eligibility and apply via the online application tool. This program is available throughout Connecticut but it is not considered an entitlement program. This means that enrollment slots are limited, and unfortunately, waiting lists of several months are common.