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 homes.
This program permits family members to be paid caregivers.
PAS also enables beneficiaries to self-direct care, with the ability to both choose their own providers, as well as have control over which types of services are provided. This program permits family members to be paid caregivers, as long as they are not legally responsible for the participant. To be clear, spouses cannot be hired to provide care. If the adult requiring care is legally incompetent, a legal guardian can direct his/her care.
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. This program is offered under the state’s regular Medicaid program (as opposed to a Medicaid waiver). Regular Medicaid is an entitlement, and therefore, there are no waiting lists for 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 2020, the limit is set equal to the Federal Poverty Level (FPL) at $1,063 / month or $12,760 / year. For married couples, the income limit is slightly higher at $1,437 / month or $17,240 / 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 his/her income, he/she may still qualify. If after paying his/her expenses, the applicant is left with less than $392 / month in income, he/she will very likely be eligible for Medicaid PAS. Please note: This figure of $392 remains the same for a single applicant, as well as a married couple.
Assets– in 2020, single applicants over 65 are restricted from having over $4,000 in countable assets, and married couples can have up to $6,000. Countable assets exclude a home (unless one’s home equity value is greater than $595,000), vehicle, and personal items. It is critical that persons over the asset limit do not gift cash / assets, or sell them cheaply, in an attempt to meet Medicaid’s asset limit. This is because there is a look-back period in which Medicaid checks past asset transfers 60-months preceding one’s application. If one has violated this rule, a period of Medicaid disqualification will be the penalty. Learn more here.
Residential – applicants must be a legal residents of the state of Nebraska. However, no length of residency is required. Therefore, persons moving to the state can become eligible for the PAS program, 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 status or are over the income and / or asset limit(s) 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. The intent is to help persons remain living at home instead of moving into residential care. Services are directed by program participants instead of the administering agency. This can include daily support with tasks such as basic hygiene, bathing, toileting, mobility, nutrition, and medication 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.
To apply, one should contact his/her local branch of Nebraska’s Department of Health and Human Services. Additional, but limited, information about Personal Assistance Services can be found here.
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 (minus spouses and legal guardians), as long as the provider has passed through the state’s approval process.