District of Columbia Medicaid Personal Care & Adult Day Health Care

Program Description

Both adult day health care and personal care assistance are available under the state Medicaid plan in the District of Columbia. These Long Term Care Services and Supports (LTCSS) help eligible DC seniors continue to live in their own home or the home of a relative, often effectively delaying more costly nursing home placement. This is a win-win for the state and for program participants, as most seniors prefer to live in, and receive assistance in their homes and the state saves money by paying for care that costs less than a full-time nursing home care.

Assistance with Activities of Daily Living, such as bathing, dressing/undressing, personal hygiene, and mobility is available in one’s home via Personal Care Aide (PCA) Services. Via the Adult Day Health Program (ADHP), supervision, meals, assistance with ADLs, and therapeutic activities are provided at an adult day health facility.

PCA Services and ADHP are operated under the DC state Medicaid plan and are administered by the Department of Health Care Finance (DHCF).

Personal Care Aide Services and Adult Day Health are also available via the DC Elderly and Individuals with Physical Disabilities (EPD) Medicaid Waiver. Although not an entitlement program, the EPD Waiver has a higher income limit than the Medicaid state plan.

 

Eligibility Guidelines

To be eligible for Personal Care Aide Services or Adult Day Health, District of Columbia residents must be enrolled in the state Medicaid plan. For those who are elderly (over the age of 65), an applicant’s income and resources (assets) are considered. As of 2018, a senior’s income cannot be greater than $1,011.67 / month, a figure that is equivalent to 100% of the current Federal Poverty Level (FPL), and the asset limit is $4,000. However, not all of an individual’s assets count towards eligibility purposes, meaning they are exempt. Examples include one’s house, home furnishings, an automobile, and personal items, such as clothing.

If an applicant is over either or both limits, this does not automatically mean that Medicaid eligibility isn’t possible. What it does mean is that reallocation of income and assets are necessary so that they are not counted towards eligibility. For example, assets can be spent on an irrevocable funeral trust or home improvements to increase a senior’s safety, mobility, and independence. Reallocation can sometimes be complicated and one does not want to unknowingly violate Medicaid’s Look-Back Period. For these reasons, it is highly suggested one consult a Medicaid planning professional if over the income and / or asset limit(s).

Long Term Care Services and Supports, such as Personal Care Aide Services and Adult Day Health also require a functional need. Generally speaking, a senior must have difficulty performing at least one of the following ADLs within the week prior to application: bathing, dressing, toileting, walking, transferring, and eating.

 

Benefits and Services

Adult Day Health is a daytime program that provides supervision, structured activities (therapeutic, recreational, and social), meals and snacks (including special diets), medication administration, nursing services, and personal care assistance with ADLs. Transportation to and from the facility may also be available.

Personal Care Aide Services are provided by home health agencies and provide assistance with bathing, dressing, grooming, mobility, transitioning (for example; from a bed to a chair), toiletry, and eating.

 

How to Apply / Learn More

To apply for Medicaid, a senior must fill out the Combined Application for Medical Assistance. One can call the DC Department of Human Services’ Division of Economic Security Administration (ESA) at 202-727-5355 with questions or if assistance is needed. The application needs to be submitted to one’s local ESA Service Center nearest the applicant, which can be done via mail or in person.

An assessment of the need for the assistance is required once accepted by the Medicaid program. To begin the process a physician or registered nurse who is a DC Medicaid provider must fill out a Prescription Order Form.

To see a list of Adult Day Health providers in the DC area, click here.