Oklahoma’s ADvantage Program Waiver: Qualifications and Services

Page Reviewed / Updated - Feb. 2016

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.

Waiver Description

This Oklahoma Medicaid waiver is designed to help frail elders remain living in their homes, or the home of a family member, instead of in a nursing home environment.  Seniors participating in the ADvantage Program can access a variety of long term care services, such as personal care and assistance, home modifications for increased safety and access, and adult day care. 

 ADvantage has been expanded to allow family members to be paid caregivers and to offer assisted living services to the elderly.

Participants in the program have the option to let the state manage the care services they receive or self-directing their own care. Self-direction, which is also referred to as participant direction or Cash and Counseling, is through the associated program, Consumer-Directed Personal Assistance Services & Supports (CD-PASS).

Under the CD-PASS program, participants are free to choose their own personal care providers. Family members, with some exceptions, are eligible to be hired and paid to provide personal care services to the participant. Originally not available statewide, the program became available in all Oklahoma counties as of November 2015.

Another option available under ADvantage, is assisted living. Formally called the Assisted Living Service Option (ALSO). ALSO is available to all program participants.

 

Eligibility Guidelines

In order to be eligible for this waiver, an applicant must be a resident of Oklahoma. Age, functional ability, income, and assets are also all qualifying criteria for the ADvantage Program. Age and functional ability are related. Persons 21 and over are eligible if the Social Security Administration designates them as disabled. Persons 65 and over do not require full disability; instead they must have a need for the level of care provided in nursing homes.

Financially, the ADvantage Waiver requires that applicants qualify for Oklahoma's Institutional Medicaid. Medicaid in Oklahoma is also referred to as SoonerCare. The SoonerCare income limit for 2016 for a single applicant is $2,199 / month, which is equivalent to 300% of the Federal Benefit Rate. The countable resources limit is $2,000. However, certain assets are considered exempt. For instance, an applicant’s primary home, given he or she lives in it, and it is valued under $552,000, is exempt. If the individual is married and their spouse is not applying for Medicaid, the spouse is allowed to have higher income, ($2,980 / month in 2016) and more assets ($119,220 in 2016).

Those who do not qualify for Medicaid financially, might be interested in Medicaid planning assistance, as these experts can usually help them to re-structure their assets and income so that they qualify.  Read more.

 

Benefits and Services

The ADvantage Waiver is intended to help the elderly remain living at home. Therefore, the available benefits are selected with that goal in mind. Waiver participants can be approved to receive any of the following services.   Certain unskilled services, most relevantly personal care, are available for self-direction.  

  • Adult Day Health Care / Adult Day Care
  • Assisted Living – Assistance with laundry, preparing meals, housecleaning, mobility, hygiene, etc. 
  • Case Management
  • Disposable Medical Supplies
  • Home Modifications for Improved Access – Ramps, lifts, roll-in showers, widening of doorways, etc. 
  • Home Delivered Meals
  • Hospice Care
  • Occupational Therapy
  • Personal Assistance Services
  • Personal Care – Aid in activities of daily living, such as bathing and dressing
  • Physical Therapy
  • Prescription Drugs
  • Specialized Medical Equipment
  • Speech Therapy
  • Respite Care
  • Nursing / Skilled Nursing
  • Personal Emergency Response System (PERS)
  • Transition Services from Institution
  • Restorative and Supportive Assistance – For individuals with a chronic condition that is stable, such as a need for an external catheter

 

How to Apply / Learn More

The ADvantage Waiver is a SoonerCare program managed by the Aging Services Division of the Oklahoma Department of Human Services.  It has replaced two older state waivers, My Life; My Choice and Sooner Seniors.  

While available throughout Oklahoma, waiting lists may exist. The waiver's CD-PASS option, where family members are eligible to be hired and paid as caregivers for their elderly relatives, is currently available throughout the state. 

To apply, contact your local Department of Human Services Office or call 1-800-435-4711. More information is available here.

There are other options available to senior citizens in Oklahoma that do not have waiting lists: Adult Day Care Services and In Home Assistance Services.