Under PPP, family members can be hired as paid personal care providers.
Recognizing the needs and preferences of many of the state’s seniors, New Jersey’s Medicaid program offers the Personal Preference Program (PPP). The PPP provides financial assistance to elderly and / or disabled, Medicaid-qualified residents to help them live independently and manage their activities of daily living.
Based on the “Cash and Counseling” model, the program distributes to participants a budget that would otherwise be spent on services for them. Participants have the power to select their own care providers. Program participants can hire friends and family members, so relatives, including spouses, can be paid to be caregivers if they are at least 18 years old. Program participants who are cognitively challenged or unable to direct their own care can still participate in the program, given they elect a representative to assist in making decisions on their behalf. The representative may be a friend or relative, but cannot also be the hired caregiver. A fiscal intermediary agency handles the financial responsibilities, such as processing payroll and deducting taxes.
This program and the category of programs are referred to by many different names. The Personal Preference Program might also be referred to as Personal Care Assistance (PCA) services. Cash and Counseling programs, in general, are also known as consumer direction, self-direction and participant-direction.
Program candidates must have a need for assistance with their activities of daily living, such as bathing, toileting, and eating as determined by a healthcare professional. However, their needs cannot be so severe that full-time nursing home level care is required.
Candidates must be financially eligible for NJ Medicaid (FamilyCare) Plan A. These requirements vary depending on one’s marital status and whether one’s spouse is also applying.
Individuals Applying for Medicaid – In 2020, seniors can have up to $2,349 in monthly income ($28,188 annually). Persons over that limit may still qualify if they have excessively high medical expenses. This pathway to eligibility is often referred to as medically needy. That said, it’s important to note that the medically needy income limit is much lower than the abovementioned income limit. NJ also allows applicants who are over the gross monthly income limit to use a special type of account to ensure that they spend their excess income on medically necessary goods or services. Individual applicants can have countable assets valued at $2,000, which does not include the equity value of their home, up to $893,000.
Couples Applying for Medicaid – In 2020, married couples, with both spouses as applicants, can have up to $4,698 in monthly income, or put differently, each spouse can have as much as $2,349 / month in income. The couple can have $3,000 in countable assets. Their home and vehicle are non-countable assets and don’t count towards the $3,000 limit. However, as previously mentioned, home equity valued at more than $893,000 is not considered exempt.
Couples with One Spouse Applying – Persons in this situation have considerably more flexibility when seeking Medicaid. In 2020, the non-applicant spouse can have up to $128,640 of the couple’s joint resources. (This is commonly called a community spouse resource allowance and is in addition to the $2,000 in assets the applicant spouse can retain). In addition, an applicant spouse’s income, up to $3,216 / month, can be allocated to the non-applicant to provide him or her with sufficient financial resources on which to live. (This is called a monthly maintenance needs allowance). This calculation includes accounting for local housing costs. Shifting income from the applicant spouse to the non-applicant spouse can also lower the applicant’s income to the acceptable limit.
One of the best things about the Personal Preference Program is that participants have a great deal of flexibility on how to spend the funds given to them for their care. We divide the types of expenditures into three categories that are considered eligible.
1) Personal Assistance Services – a hired individual that assists the program participant to manage his or her activities of daily living, and instrumental activities of daily living such as bathing, grooming, meal preparation, eating, mobility, housekeeping, shopping and laundry.
2) Assistive Technology – appliances, devices, and controls that increase the individual’s ability to live independently, such as remote controls, specially designed cooking equipment, and motion-sensitive lighting.
3) Home Modifications – changes to one’s home to accommodate for physical challenges, such as stair glides, handicap ramps, walk-in tubs, grip bars for the bathroom, and doorway alterations to accommodate for wheelchairs.
This program is managed by the New Jersey Division of Disability Services (DDS), which is within the NJ Department of Human Services (DHS). A downloadable PDF about PPP is available here and additional information is found on the DHS’ website. Questions can be directed to DDS at 1-888-285-3036. To apply for the PPP program, one must be accepted into Medicaid in New Jersey and should then contact his or her Managed Care Organization (MCO). To apply for NJ Medicaid, one can start here.