Description
The Services My Way (SMW) program is designed for Medicaid eligible Pennsylvania residents who are elderly and / or disabled. Participating individuals get to self-direct their care by choosing their own care providers instead of the state agency making those decisions on their behalf. This model is 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 care manager/service coordinator 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,” who is responsible for making payments to the care providers that are approved by the program participant.
Eligibility Guidelines
General Requirements
To qualify for Services My Way, Pennsylvania residents must be enrolled in Community HealthChoices (CHC).
Functionally, CHC participants must require a nursing home level of care.
Financial Requirements
Income Limits
For 2023, single or widowed individuals age 65 or older are permitted up to $2,742 per month ($32,904 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 may be able to redirect some, or all, of the applicant spouse’s income to the non-applicant spouse. This is called a “monthly maintenance needs allowance.” This spousal allowance is intended to make sure the non-applicant spouse has enough income to live on, while effectively lowering the applicant spouse’s income. For 2023, the maximum monthly maintenance needs allowance is $3,715.50.
Assets Limits
When using the 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, Pennsylvania allows a $6,000 disregard. In the situation of a married couple with only one spouse applying for Medicaid, the non-applicant spouse can have up to $148,620 (in 2023) 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, the value of the applicant’s home equity cannot be greater than $688,000.
Please Note: When reviewing an applicant’s financial status, state officials will look at the individual’s asset transfers as far back as five years. This is called the Medicaid look-back period. Assets are not allowed to be gifted in order to meet financial requirements, otherwise the individual will be penalized with a period of Medicaid ineligibility.
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.
Benefits and Services
The Services My Way 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.
- Adult Day Services
- Chore Services
- Community Transition Services
- Companion Services
- Counseling
- Financial Management Services
- Home Delivered Meals
- Home Health Care
- Household Services (light housecleaning, laundry, meal preparation)
- Home Modifications
- Medical Supplies and Equipment
- Personal Assistance Service
- Personal Care
- Personal Emergency Response System (PERS)
- Respite Care
- Transportation
How to Apply / Learn More
To utilize the Services My Way option of the Community HealthChoices (CHC) program, participants first need to be enrolled in Pennsylvania’s Medicaid. One can enroll for PA Medicaid online here. To apply over the phone, call the Consumer Service Center for Health Care Coverage at 1-866-550-4355.
Once enrolled in Medicaid, one can start the process of applying for CHC. Here are the steps involved in applying:
- The applicant calls the PA Independent Enrollment Broker (PA IEB) at 877-550-4227.
- PA IEB requests a completed physician’s certification form from the applicant’s doctor.
- First in-home visit.
- Second in-home visit.
- The PA IEB reviews both the assessments from the in-home visits and the physician’s certification form. If the applicant meets the eligibility requirements, the application is forwarded on to the County Assistance Office (CAO).
- The CAO reviews the application for financial eligibility and provides a final decision within 90 days.
Some limited information on Services My Way is available here.
