This Oklahoma Medicaid waiver is designed to help frail elders remain living in their homes, or the home of a family member, instead of in a nursing home environment. Seniors participating in the ADvantage Program can access a variety of long term care services, such as personal care and assistance, home modifications for increased safety and access, and adult day care.
ADvantage has been expanded to allow family members to be paid caregivers and to offer assisted living services to the elderly.
Participants in this program have the option of letting the state manage the care services they receive or self-directing their own care. Self-direction—also referred to as participant direction or Cash and Counseling—is through the associated program option, Consumer-Directed Personal Assistance Services & Supports (CD-PASS).
Under the CD-PASS program option, participants are free to choose their own personal care providers. Family members are eligible to be hired and paid to provide personal care services for the participant. While some exceptions exist, in some conditions spouses and legal guardians can be paid to provide care. Originally not available statewide, the program became available in all Oklahoma counties as of November 2015.
Another option available under ADvantage is assisted living. Formally called the Assisted Living Service Option (ALSO). ALSO is available to all program participants.
To be eligible for this Medicaid waiver, an applicant must be a resident of Oklahoma. Age, functional ability, income, and assets are also all qualifying criteria for the ADvantage Program. Age and functional ability are related. Persons 21 years of age and over are eligible if the Social Security Administration designates them as disabled. Persons 65 and over do not require full disability; instead they must have a need for the level of care provided in nursing homes.
Financially, the ADvantage Waiver requires that applicants qualify for Oklahoma’s Institutional Medicaid. Medicaid in Oklahoma is also referred to as SoonerCare. The SoonerCare income limit for long term care services, as of 2022, for a single applicant is $2,523 per month. The countable resources limit is $2,000. However, certain assets are considered exempt. For instance, an applicant’s primary home, given he or she lives in it, and the equity value is under $636,000, is exempt.
If the applicant is married and his or her spouse, often referred to as the community spouse, is not applying for Medicaid, there are spousal impoverishment standards in place. This is intended to prevent the community spouse from having too little income and assets in which to properly live. As of 2022, in over simplified terms, the non-applicant spouse is entitled to up $3,435 per month of the applicant’s income. In addition, the community spouse is entitled to one half of the couple’s joint savings and retirement accounts, up to $137,400 in 2022.
Couples interested in preserving as much of their retirement savings as possible should consult a Medicaid planning adviser. These experts can usually help to restructure assets and income so that couples can maximize the spousal allowances and ensure eligibility. Read more.
Please note: It is vital that applicants do not give away cash and other non-exempt assets in an effort to meet the asset limit. Gifting countable assets, or selling them for less than they are worth, within 60-months of filing a Medicaid application violates Medicaid’s look-back period. This can cause a period of Medicaid ineligibility, defeating the purpose of trying to meet the asset limit.
The ADvantage Waiver is intended to help the elderly remain living at home. Therefore, the available benefits are selected with that goal in mind. Waiver participants can be approved to receive any of the following services. Certain unskilled services, most relevantly personal care, are available for self-direction.
The ADvantage Waiver is a SoonerCare program managed by the Aging Services Division of the Oklahoma Department of Human Services. It has replaced two older state waivers, My Life; My Choice and Sooner Seniors.
While available throughout Oklahoma, waiting lists may exist. The waiver’s CD-PASS option, where family members are eligible to be hired and paid as caregivers for their elderly relatives, is currently available throughout the state.