Connecticut Personal Care Assistance (PCA) Program

 What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services. 


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 are permitted to be hired. The 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 are automatically moved to the CFC. The advantage is that the CFC option does not have waiting lists for services, as are common for this program.

 Did You Know?  In 35 years, the number of persons living past 100 is projected to be 15 times higher than it is today.


Eligibility Guidelines

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 need hands-on assistance with at least two of their activities of daily living, such as bathing, eating, meal preparation or 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 which follow for the year 2018.

CT Personal Care Income Limits - single applicants are not permitted to have more than $2,250 in monthly income. Married individuals can exceed that limit provided their spouse is not also applying for Medicaid. Under this scenario, some income can be allocated to the spouse.

CT Personal Care Asset Limits - single applicants can have up to $1,600 in countable resources. An owner-occupied home, 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 $123,600.

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.

 Please note, financial eligibility for Medicaid is exceedingly complex. The above rules have been simplified to provide an easier understanding of the program. Married couples, persons exceeding these fixed limits and persons unsure of their eligibility should consult with a Medicaid planning professional familiar with CT Medicaid nuances.


Benefits and Services

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.

A recent change to this program has added a new benefit called Adult Family Living which we have written about extensively here


How to Apply / Learn More

More information about the PCA program can be found on the CT Medicaid website 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 using their online application tool. This program is available throughout Connecticut but it is not considered an entitlement program and waiting lists of several months are common.