Pennsylvania Department of Aging Medicaid Waiver

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 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, several services are covered in addition to the basic personal care services. 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.

 Did You Know? PA Seniors can receive free quotes for home safety and access improvements such as walk-in tubs to replace showers and stair glides for indoor and outdoor staircases.  


Eligibility Guidelines

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
Pennsylvania Medicaid’s long term care eligibility standards allow seniors and disabled individuals under 65 to access these services with higher incomes. The income limit for an individual applying for a PA Medicaid waiver is $2,205 per  month. If one spouse is applying for Medicaid and the other is not, only the applicant’s income counts towards the goal, following the ‘name on the check’ rule.

The asset limit for the PDA waiver is $8,000. Resources more than that amount must 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 more than $8,000 are permitted. Half of the total countable net worth of the couple can be exempted, up to a maximum of $120,800. 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 when the incomes are over the income limits.  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 per month (this is an approximate amount for 2017), 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. Couples can exempt two funeral trusts. Learn more about Medicaid planning.


Benefits and Services

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.  

  • Adult Daily Living Services
  • Attendant Care (Personal Care)
  • Community Transition Services (Moving Assistance)
  • Companion Services (Escort)
  • Counseling
  • Environmental Accessibility Modifications (Home and / or Vehicle)
  • Financial Management Services
  • Home Health Services
  • Home Medical Equipment and Supplies
  • Meal Delivery (Hot or Prepared)
  • Non-Medical Transportation
  • Personal Emergency Response (PER) System
  • Respite Care Services (Temporary Caregiver Relief)

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.


How to Apply / Learn More

Although up to 28,000 Pennsylvanians can receive services through this waiver, if demand exceeds this figure, then waiting lists may exist for some Pennsylvania counties.

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.  

One can learn more about the program on the following website. To apply individuals should contact their local County Assistance Office.

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