Consumer Directed Attendant Services (CDAS) is a Medicaid entitlement program though Maine’s state Medicaid program. (Medicaid in Maine is more commonly referred to as MaineCare). CDAS covers personal or attendant care provided to Medicaid recipients in their homes or certain group living environments, as long as personal care services are not already provided. Under this program, participants are empowered to select, hire, train, and manage their own care providers instead of having the state administrators select caregivers on their behalf. This consumer directed model of care is also referred to as participant direction, self-direction, and cash and counseling. To avoid confusion, it is worth mentioning that these services are also referred to as personal care attendant (PCA) services, or simply attendant services.
Under CDAS, the adult children of aging parents can be paid to provide caregiving services.
It is the intention of this program to help individuals remain living in their homes by providing care services in that environment instead of requiring individuals to move into nursing home residences. As mentioned previously, consumers are able to select their own personal care providers, with certain family members being among those who are eligible to be paid caregivers. Parents and spouses are not able to be hired, but the adult children (of aging parents) could become paid caregivers provided they were not also the legal representative of their parent.
Maine has a similar program with consumer direction for non-Medicaid eligible seniors called the Home Based Care Program.
To be eligible for the MaineCare CDAS program, participants must be at least 18 years of age and have a permanent and verifiable disability that limits their ability to care for themselves and manage their activities of daily living. Individuals cannot reside in a hospital, nursing home, intermediate care facility or other private, non-medical, residential care facility, commonly called assisted living or board and care homes. They also cannot concurrently be receiving care services from other MaineCare programs in which personal care is offered. Finally, they must be financially eligible for MaineCare. Financial eligibility looks at both an applicant’s income and his or her “countable assets”.
Income Eligibility – Single senior applicants are subjected to a monthly income limit or $1,133 as of January 2022. This amount is equivalent to 100% of the Federal Poverty Level (FPL). For applicants who have income over the limit, Maine offers an alternative pathway to eligibility for “medically needy” persons. Medically Needy individuals have high medical expenses that they cannot afford to pay even though they have income over the limit mentioned above. This is a determination made by the state. It may be advantageous to consult with a private Medicaid expert prior to pursuing this approach. Learn more.
Countable Asset Eligibility – The effective asset limit for a single person is $10,000 in cash and savings. Countable assets do not include one’s home if the value of the home equity is not greater than $955,000. Also exempt are personal items, furniture, and two cars. Being over the asset limit does not mean automatic disqualification from CDAS. Strategies exist to help families meet the asset requirements. However, it is extremely important that one does not give away cash or other countable assets in an effort to lower one’s assets to the allowable asset limit. Doing so may violate Medicaid’s look back period and can result in a penalty, delaying needed Medicaid benefits.
Benefits and Services
The exact services provided under the CDAS program are specific to the participating individual and are determined during enrollment in the program. Participants are re-assessed periodically to ensure their needs are continuing to be met. Participants can qualify for three different tiers of Personal Care Services (PCS) up to a maximum of 28 hours / week. PCS can include any or all of the following:
- Assistance with the Activities of Daily Living (ADLs), such as bathing, personal hygiene, dressing, mobility and transfer assistance, eating, and using the toilet.
- Assistance with the Instrumental Activities of Daily Living (IADLs), such as grocery shopping, meal preparation and clean up, housekeeping, laundry, and assistance with money management.
- Assistance with health maintenance activities, such as medication administration, physical / occupational activities, and catherization.
- Care Coordination Services / Case Management (up to 18 hours / year)
- Skills training for the individual hired as a Personal Care Attendant (up to 14.25 hours / year)
Personal care can be provided to individuals residing at home, in the homes of their loved ones.
How to Apply / Learn More
The CDAS Program is run by the Maine Department of Health and Human Services; persons should contact their local office. A list of offices and their contact information is available here. One can also read more about the program in the very comprehensive MaineCare benefits manual available here.