Page Reviewed / Updated - Jan. 2016
This Medicaid Waiver provides home and community based services to seniors who require nursing facility care but elect to live in their own homes or in other community living arrangements and receive care in those locations. It is also referred to as the PA Council of Aging Waiver, the PDA Waiver, the Office of Long Term Living (OLTL) Waiver or the Home and Community-Based Waiver for Individuals Aged 60 and Over.
The program's objective is not just to reduce nursing home admissions, but to help seniors function independently in their homes. As such services beyond personal care are covered. Support is available to family members caring for loved ones such as adult day care and respite care. The program also pays for home medical equipment and minor home modifications to improve home access (wheelchair ramps, stair glides) and home safety (walk-in bathtubs, safety bars).
Under the PDA Waiver, certain goods, supports and services can be participant directed or self-directed. This means the individual chooses from whom they purchase goods or care services. Participants in this waiver can elect to have even greater control of their care providers by requesting their services through a program called the Services My Way Program.
In addition to living in PA, residents must be at least 60 years old and require the level of care typically provided in a nursing home. They also must qualify financially for Medicaid in Pennsylvania, which is sometimes called "Medical Assistance" or abbreviated MA. Financial eligibility is determined at the county level but the following information is sufficiently accurate for planning purposes.
PA Medicaid Eligibility Requirements for 2016
The income limit for an individual applying for a PA Medicaid waiver is $2,199 / month. If one spouse is applying for Medicaid and the other is not, joint income can be shifted to help the applicant qualify. The maximum monthly income a non-applicant spouse can have is $2,980.50.
The asset limit for the PDA waiver is $8,000. Resources in excess of that amount will need to be spent down or re-allocated into exempt (non-countable) assets. In the situation previously described, where one spouse of a married couple is applying, resources in excess of $8,000, up to a maximum of $119,220 can be allocated to the non-applicant spouse. This is referred to as the Community Spouse Resource Allowance.
Applicants Who Exceed These Limits
PA has a Medically Needy Medicaid program that enables residents with unusually high care costs to qualify for the program. In brief, Medically Needy programs work by looking at the difference between a candidate's monthly care expenses and their monthly income. Should their expenses be so high that their remaining "disposable income" is less than $425 / month (this is an approximate amount for 2016), they can then gain eligibility.
Alternatively, Medicaid planning professionals can work with a family to arrange their assets and income into annuities and trusts so that they meet the eligibility requirements. For example, by pre-funding a funeral using an irrevocable funeral trust, one can reduce their countable assets by up to $15,000. Learn more about Medicaid planning.
The services provided under this waiver are determined on a needs basis. Individuals can be approved for any of the following and there is no limit on how many of these can be received by any single beneficiary.
Assisted Living / Adult Foster Care Clarification - Under this program, assisted living and adult foster care are not covered benefits in name but the waiver does cover "older adult daily living services" which can be provided to individuals who reside in these locations. However, the cost of room and board is not covered.
While previously only available in certain areas of the state, the PDA Waiver is now available statewide in all 67 counties. Unfortunately, availability does not ensure assistance, this is not an entitlement program. This means that even though one meets all the eligibility requirements, it does not necessary guarantee they will immediately be able to receive services. Waiting lists can exist for those who qualify. However, they are managed at the county level therefore in some areas there may be immediate availability and in other areas a wait may be required.
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