Page Reviewed / Updated - February 29, 2020
The Minnesota Medicaid Personal Care Assistance Service is not a program per se, but rather a different way to receive aging social services. Participants hire a Personal Care Assistant (PCA) who helps them to manage their Activities and Instrumental Activities of Daily Living, such as bathing, eating and basic mobility. The funds to pay for the PCA come from the different health service groups.
Participants have the option to self-direct their personal care service, which offers a great deal of flexibility regarding whom persons are able to hire to help with their activities of daily living. Friends, neighbors, and family members, including adult children and spouses, can be employed as the Personal Care Assistant or, essentially, a caregiver.
This concept is based on the Cash and Counseling Model, where individuals are provided with access to cash and they receive the counseling they require to arrange their own care services. By transferring the administration of care services to the individual, the state saves money on administration costs and the individual gains flexibility and control.
It should be noted that Cash and Counseling—in more modern language—is called consumer or participant direction. One might also hear the PCA Program referred to as a PAS (Personal Assistance Service) Program and PCA Choice Option.
To be eligible for a Personal Care Assistant, one must participate in one of the following four programs:
These programs all generally require that the individual have a low annual income, limited resources, and be at least 65 years old or disabled. However income and asset limits vary by program and marital status. For instance, as of 2020, in order for a senior to be eligible for Minnesota’s state Medicaid program under the Elderly, Blind, Disabled pathway, a single applicant must have monthly income less than $1,041, and assets under $3,000. For married applicants (both spouses applying), the income limit is $1,410 per month and the asset limit set at $6,000. (Please note, the above income limits are effective from July 1, 2019 to June 30, 2020.)
For the Elderly Waiver, the income limit is significantly higher, and is set at $2,349 per month for a single applicant, and the asset limit is $3,000. Married applicants (again, both spouses applying), are allowed up to $2,349 / month per spouse, as each spouse is considered as an individual applicant. However, assets are considered jointly owned in this scenario, and the couple is able to retain up to $6,000 in assets. (Learn more about Medicaid and jointly owned assets).
Participants must be assessed by a social worker with the county department of health to determine a medical need for personal care assistance. Furthermore, a physician must deem personal care assistance as necessary.
Individuals who are over the income and/or asset limit(s) should not be discouraged. Those with high medical bills in relation to their income may qualify through the Medically Needy pathway for Medical Assistance. This is often referred to as a “Spend-Down” Program, and the “spend-down” amount thought of as a deductible. Unfortunately, the above program is not helpful for those over the asset limit, but persons can spend assets over the limit on assets that are not counted towards eligibility. For instance, the addition of a first floor bedroom, replacing the roof, and making home modifications to encourage aging in place, are all ways to lower one’s countable assets. However, if one is over the income limit and/or the asset limit, it is advisable to seek the advice of a Professional Medicaid Planner prior to filing a Medicaid application.
Due to the variety of providers and choices, getting started with PCA Choice is somewhat complicated. The easiest way to do so is by contacting your county health office to schedule a care needs assessment. A complete list of county contacts, office locations, and telephone numbers is available here.
Complete information about the program is available in the Personal Care Assistance Program Manual. One can also find information about this program on Minnesota’s Department of Human Services website.