Personal Care Attendant Services (PCAS) are provided via the state Medicaid plan for physically disabled residents of New Hampshire. While one must be wheelchair-bound the majority of the time, this program is still relevant for aging seniors, as some conditions that become more common with aging, such as rheumatoid arthritis and strokes, can qualify one for this program. Personal Care Attendants provide assistance with the Activities of Daily Living (ADLs), such as personal hygiene, dressing, mobility, and transferring, as well as aid with Instrumental Activities of Daily Living (IADLs), such as the preparation of meals, laundry, and grocery shopping. Health maintenance support, such as medication administration and incontinence (the inability to control one’s bladder or bowel movements) care, is also provided. These services are intended to promote seniors’ independence and to help avoid nursing home placement until absolutely necessary. Services may be provided in one’s home, the home of a relative, or an adult foster care home.
Applicants are able to self-direct their own care, which means they are able to hire and manage the personal care attendant of their choosing. Friends can be hired to provide care, but relatives cannot be hired. However, personal care attendants must go through an Attendant Care Education Orientation run by the Center for Independent Living, Granite State Independent Living (GSIL). Personal care attendants are under the authority of a GSIL registered nurse.
To receive PCAS through New Hampshire’s state Medicaid plan, one must first be enrolled in Medicaid. For seniors (65 years of age and older) the income limit, as of 2020, is $797 / month, and the asset (resource) limit is $1,500 / month. While the asset limit might seem low, one’s home (up to an equity value of $595,000, as of 2020) is exempt if the applicant or the applicant’s spouse lives in it. Other exemptions include household furnishings, pre-paid burial plans, a life insurance policy with a face value up to $1,500, and an automobile.
For those over the income and asset limits, it’s possible to still qualify for Medicaid. For those with excess income, the state of New Hampshire has a Medically Needy Pathway, which means those who have high, recurring medical bills can deduct these bills from their monthly income, effectively lowering their countable income. It’s important to note that the medically needy income limit is different from the income limit above. As of 2020, the Medically Needy Pathway limits one’s monthly income to $591 after medical deductions.
For applicants with excess assets, assets over the limit can be “spent down” on home modifications to improve accessibility, on debt, and on irrevocable funeral trusts. When spending down assets to reach Medicaid’s asset limit, it is vital that one does not give away assets or sell them under fair market value. Doing so is in violation of Medicaid’s 60-month look back rule and can result in a period of Medicaid denial.
Seniors who are over the income and / or asset limit(s) are highly encouraged to seek the counsel of a professional Medicaid Planner, who can assist in reallocating income and assets in order for one to qualify for Medicaid.
Other qualifications of the PCAS program are as follows:
Up to approximately 40 hours / week (though one may be approved for more than 40 hours) of personal attendant care can be provided via this program. Personal care attendants provide health maintenance support (bowel/bladder care, ostomy care, administering of medications, etc.) and assistance with ADLs and IADLs (bathing, dressing, grooming, shaving, nail care, oral hygiene, using the toilet, transferring from a lying position to a seated position, medication assistance, light housekeeping, shopping for groceries).
Program participants are able to hire and train the personal care attendant from which they would like to receive services. This benefit is referred to as Consumer Directed or Participant Directed.
Applicants for the Personal Care Attendant Services Program must first be enrolled in Medicaid. To apply for Medicaid, persons need to contact their local New Hampshire Department of Health and Human Services’ office.
To learn more about the Personal Care Attendant Services Program, click here. One can also call Granite State Independent Living at 603-228-9680 or 800-826-3700 for additional information or to apply (if already on Medicaid) for PCAS. Registered nurses from GSIL determine functional eligibility for Personal Care Attendant Services.