Page Reviewed / Updated - March 18, 2020
The Services My Way (SMW) Program is designed for Medicaid eligible, Pennsylvania residents who are elderly and / or disabled. Services are provided on the Cash and Counseling model in which the participating individuals self-direct their care by choosing their own care providers instead of the state agency making those decisions on their behalf. This model is also referred to as consumer-direction or participant direction. The SMW Program is not a Medicaid waiver per se, but rather is a way that waiver participants can receive services.
Participants work with a Case Manager from the state to collaboratively determine their needs and a budget for care services and goods. This is referred to as their 'Individual Service Plan.' Participants then determine when, where, and from whom to purchase the necessary goods and services.
Neighbors, friends, and even certain family members can be hired as paid caregivers. This includes the adult children of the participating elders, but not spouses or legal guardians. This optional way to receive services at home can be particularly helpful when the care recipient’s first language is something other than English.
The Services My Way Program makes use of a fiscal intermediary also referred to as an Employer Agent that is responsible for making payments to the care providers that are approved by the program participant.
To qualify for the SMW Program, PA residents must be qualified for either the PA Community HealthChoices Program (for persons aged 21 and over) or the Attendant Care Program (for persons aged 18-59), both of which are Medicaid programs. The non-financial requirements for these programs assert that the individual must require nursing home level care. The financial requirements are age and marital status dependent.
2020 PA Medicaid Waiver Income Limits
A single or widowed individual aged 65 and older is permitted up to $2,349 per month ($28,188 per year) in income. Individuals with income in excess of that amount may still qualify either through a Medicaid Spend Down program or by working with a Medicaid planner to re-direct excess income into a pooled income trust. Married couples with a single applicant can re-direct some, or all, of the applicant spouse’s income to the non-applicant to lower the applicant's income. This is called a monthly maintenance needs allowance. This spousal allowance is especially relevant for older couples in which the applicant spouse receives the vast majority of their income in his or her name.
2020 PA Medicaid Waiver Assets Limits
When using Services My Way option with the Community HealthChoices Program, the countable asset limit for an individual is effectively $8,000. This is because in addition to the $2,000 asset limit, PA allows a $6,000 disregard. In the situation of a married couple with one spouse not applying for Medicaid, that spouse can have up to $128,640 of the couple’s joint countable resources. This is called a community spouse resource allowance.
It is important to note what is and is not considered "countable." The primary vehicle is exempt as well as funeral trusts and burial plans. The home is also exempt provided it is lived in by the owner(s). It cannot be a rental property. Also, important, the value of the applicant's home equity cannot be greater than $595,000.
When reviewing an applicant's financial status, state officials may look at the individual's asset transfers as far back as five (5) years. This is called the Medicaid look-back period. If one has any uncertainty regarding his or her Medicaid eligibility, a Medicaid planning professional can make the process of enrollment a lot easier. A rejected or incorrect application could significantly delay benefits. Learn more.
The SMW Program covers a wide range of services and goods. The specific benefits for which a participant is eligible are determined with one's case manager in his or her Individual Service Plan and may include any of the following. Not all services can be self-directed.
The Services My Way Program is available statewide in all PA counties. Residents with questions about how this program works should check with the PA Long Term Care Helpline at 1-866-286-3636.
One can begin the application process by calling the PA Office of Long Term Care Helpline at 1-866-286-3636 or by contacting their Area Agency on Aging. Alternatively, some limited information is available on the Services My Way webpage.