Oklahoma Assisted Living and In Home Medicaid Waiver Information and Rules for 2017

Introduction

Oklahoma provides long-term care resources to seniors through the Oklahoma State Department of Health and theOklahoma Department of Human Services, which oversees the Medicaid waiver program. In addition, the Department of Human Services provides numerous aging resources and services, including the state-run Adult Day Services program. Adult Day Services is a community-based program designed to meet the needs of functionally impaired older persons, generally those aged 60 and over, through an individualized plan of care. The program assists participants to remain in the community, enabling families and other caregivers to continue caring for an impaired member at home. For more information on the state Adult Day Services program, you can reach them by phone at (405) 521-4229 or 1-800-498-7995. Additional senior services include legal help, transportation assistance, and many other resources to help with long-term care.

Medicaid Waiver Program for Assisted Living and In-Home Care

Oklahoma ADvantage Medicaid Waiver (HCBS Advantage Waiver)

The ADvantage Program is a home and community-based alternative to placement in a nursing facility to receive Medicaid-funded assistance for care.

TheADvantage Program is for the frail elderly and adults with physical disabilities age 21 and over who do not have intellectual disabilities or a cognitive impairment. The ADvantage Administration Unit oversees the day-to-day operation of the ADvantage waiver program. Under the Medicaid Home and Community-Based Waiver ADvantage Program, the Oklahoma Department of Human Services, Division of Aging Services, offers services to eligible adults as an alternative to care in a nursing facility. The goal of this program is to provide services which allow Medicaid eligible persons who need nursing facility level of care to remain at home or in the residential setting of their choosing while receiving the necessary care.

Services

Services include: Case management, transitional case management, advantage personal care, advanced supportive/restorative, skilled nursing - home health setting, RN assessment evaluation, occupational therapy, physical therapy, respiratory therapy, speech/language therapy, adult day health, personal care in adult day health, therapy in adult day health, home-delivered meals, nursing facility extended respite (8+hrs), in-home respite, in-home extended respite, environmental modifications, hospice, and specialized medical equipment and supplies

Eligibility

  1. Health: Applicants must require a nursing home level of care.
  2. Financial: Applicants must meetcertain financial criteria, including income and asset limits to receive institutional Medicaid benefits. The state follows the Special Income Limit (equal to 300% of the Federal Benefit Rate, “FBR”); which, for 2017, means the indivudal income limit is $2,205. The asset limits are $2,000 for an individual and $3,000 for a married couple if both are applying. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust), can allow them to access the benefitsby funneling their income into the trust for purposes of paying for care and meeting the income limit. A non-applicant spouse is allowed to keep a certain amount of assets and monthly income without affecting the applciant’s financial eligibility. For 2017, the non-applicant spouse may keep up to $120,900 in assets and receive up to $3,022.50 in monthly income for personal needs.

Practical Considerations

Through theADvantage Waiver, an enrollee can apply for the Assisted Living Service as part of the waiver. Assisted Living is a homelike, non-institutional setting offering services for those who may need daily assistance but not continuous nursing care. Assisted Living facilities offer services such as: daily meals, housekeeping, laundry, help with taking medications, personal care, intermittent or unscheduled nursing care, assistance with transfer and ambulation and social, recreational and exercise opportunities.

Another variation through the waiver is theConsumer Directed Personal Assistance Services and Supports (CD-PASS), which offers ADvantage Members the opportunity to direct decisions regarding personal care services. Instead of using a home care agency that sends a personal care aide to provide services, the CD-PASS service option empowers the Member and allows them to become the employer and hire their own employee, a personal assistant or PSA. Once the service plan hours are determined, the Member will negotiate pay with the employee (within the maximum limit) and develop a schedule that is suitable to both the Member and the employee.

Conclusion

Oklahoma is a good state for long-term Medicaid assisted living or in-home care benefits. The flexibility the ADvantage Waiver program provides seniors allows for a truly customized experience, ensuring that the participant is receiving the best services available. A Medicaid Planning specialist may be able to help you or your loved one qualify earlier for the ADvantage Waiver, saving you money and getting access to services faster.