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Within Nebraska’s Medicaid network of long-term services and supports (LTSS), Personal Assistance Services (PAS) are offered to applicants eligible for Medicaid who have a chronic medical condition or disability and need assistance with daily activities in their own home.
PAS also enables beneficiaries to self-direct care, with the ability to both choose his/her provider, and control over which types of services are provided. The program permits family members to be paid caregivers, as long as the person is not legally responsible for the participant. If the adult requiring care is legally incompetent, care can be directed by a legal guardian.
Operating within the broader Medicaid program, Personal Assistance Services are administered by the Special Services for Children and Adults Division under the Office of Aging and Disability Services within the Nebraska Department of Health and Human Services.
To be eligible for Personal Assistance Services, there are functional, income, asset and residential eligibility criteria.
Functional – applicants must have a chronic medical condition or disability that necessitates care at the level provided in an assisted living facility or higher. Less formally, this means they require assistance with multiple activities of daily living.
Income – income criteria for PAS under Medicaid vary with the age of the applicant. For those 65+ years of age, in 2018, the limit is set equal to the Federal Poverty Level at $1,102 / month or $12,140 / year. Alternatively, seniors may qualify with higher income via the Medically Needy pathway. In brief, should the applicant’s monthly recurring medical expenses consume the majority of their income, they can qualify. If after paying their expenses, the applicant is left with less than $392 / month in income, they will very likely be eligible for Medicaid PAS.
Assets – single applicants over 65 are restricted from having over $4,000 in countable assets. Countable assets exclude a home, vehicle and personal items (unless their home equity value is greater than $572,000). A married couple may be permitted higher levels of assets, if one spouse of the couple is not seeking Medicaid assistance. It is recommended couples in the situation or persons over the asset limit, consult with a Medicaid planner.
Residential – applicants must be a legal resident of the state of Nebraska. However, no length of residency is required, therefore persons moving to the state can become eligible as well as long-term residents.
Medicaid eligibility is complicated and there exists considerable gray areas. It is strongly suggested that persons uncertain of their eligibility consult with an advisor familiar with Nebraska Medicaid law in advance of applying. Read more.
Personal Assistance Services are covered by Medicaid for Nebraskans, of any age, who have a disability or chronic condition, with the intent of helping the person remain living at home instead of moving into residential care.
Services are directed by the program participant instead of the administering agency. They can include daily support with tasks such as basic hygiene, bathing, toileting, mobility, nutrition and medications management. Even tasks such as housekeeping can be included if the task is essential to keeping a recipient in his/her own home. With a medical professional's oversight, the personal assistant may also provide peripheral medical procedures, such as administration of catheters, oxygen, and/or injections.
Support is not limited to in-home. Benefits can be received outside the home, for example, accompanying a beneficiary to the physician's office or attending an adult day care program.
This program is offered under the state's regular Medicaid program (as opposed to a Waiver). Regular Medicaid is an entitlement and therefore there are no waiting lists for services.
To apply one should contact their local branch of Nebraska’s Department of Health and Human Services.
Once a successful applicant has been connected with a state social service worker, a Service Needs Assessment/Plan (SNA) will be created, which can authorize PCS services for up to 12 months before requiring re-certification. Beneficiaries can then choose their own provider, including the option of a family member, as long as the provider has passed through the state’s approval process.