Pennsylvania Health Law Project Seeking Individuals Institutionalized but who Prefer Long Term, In-Home Care
Pennsylvania Health Law Project Seeking Individuals Institutionalized but who Prefer Long Term, In-Home Care
Dear Friends,
Pennsylvania Health Law Project needs your help. We are seeking to identify individuals who would have liked to use Medical Assistance to support long-term care in their homes but because of excess income must receive care in institutional facilities, in nursing facilities or intermediate care facilities instead.
What is a Waiver Program?
Medicaid Home and Community-Based Services (HCBS) Waiver programs provide alternatives to treatment in long-term care facilities. These HCBS Waivers allow individuals at risk of institutionalization to preserve their independence and ties to family and friends by remaining in their communities. Pennsylvania's HCBS Waivers may serve children, adults, individuals who are elderly or all ages. Additionally, they serve individuals with certain diseases or conditions, including physical disabilities, developmental disabilities, traumatic brain injury, AIDS, etc. However, many people who need the long-term living services that HCBS Waiver programs offer and who prefer in-home services do no qualify because they have too much income for these programs.
The Current Policy for Financial Eligibility.
To be financially eligible for a HCBS Waiver program, an individual must have countable income (not counting the income of a spouse) no more than three times the federal benefit amount for SSI for an individual, i.e., not over $2,022 per month in 2009. Countable assets must be $8,000 or less (not counting the assets of a spouse). As in other Medical Assistance programs, individuals who do not meet these limits must reduce their assets and spend-down their excess income (using medical bills and expenses) in order to qualify for the program. However, instead of spending excess income down to the waiver program income limit of $2,022 each month, a consumer seeking entry in an HCBS Waiver program has to spend-down her countable income to $701 each month. Faced with the prospect of diverting so much of their income to meet this monthly spend-down, consumers rarely qualify for a waiver using a spend-down because they cannot meet their normal living expenses. Many Medicaid-eligible people, consequently, are left with just one option: to leave behind their families, neighbors, and communities to receive long-term care in the more expensive, and less preferred, institutional setting.
The Change We Seek To Bring.
To reduce the long-term care system's reliance on institutional care, PHLP is working to change this policy. Individuals with higher incomes should be permitted to spend-down their excess income to the waiver program limit of $2,022 per month instead of the current $701 per month spend-down limit. This will help more people receive long-term care in the preferred setting of their homes and communities, surrounded by family and the neighbors they have known for years.
We Need Your Help.
PHLP wants to hear from you! Do you know an elderly or disabled consumer who would prefer to remain in the community using an HCBS Waiver but cannot because his income is too high? PHLP is looking for stories about consumer struggle to become income-eligible for HCBS Waiver programs. If you have a client or a consumer who could benefit from a change in the current policy or have questions or concerns about the current policy, please contact David Gates ([email protected], 717-236-6310) or Sipi Gupta ([email protected], 215-625-9111) to discuss this further.
Thank you,
David Gates
Pa Health Law Project
1414 N. Cameron St.
Suite B
Harrisburg PA 17103
717-236-6310
717-236-6311 fax