A Modified Aging Waiver Receives Approval

Written By: Attorney Jeffrey A. Marshall, CELA*

December 2008

A significant portion of Pennsylvania’s annual budget goes to help pay for nursing home care. The state uses federal Medicaid funds to help it meet its obligation to eligible individuals who need this level of care.   

But, few people want to live in a nursing facility.  Most of us would prefer to remain in our home if that is realistically possible.  Pennsylvania has developed a number of programs that recognize this preference and offer people home care alternatives to nursing facilities. 

While family supported home care is often much less expensive than institutional care, Pennsylvania still needs federal Medicaid money to fund these home care options.  To obtain this federal financial assistance Pennsylvania must seek “waivers” from standard Medicaid rules for institutional care so that these funds can be used to provide supports and services for people in their own homes.  This federal approval allows the state to use Medicaid money for home care.

Pennsylvania has established many Medicaid waiver programs.  A listing of them is available on the Department of Public Welfare’s website at http://www.dpw.state.pa.us/ServicesPrograms/MedicalAssistance/003670306.htm

The waiver program that is most important for seniors is the “Aging Waiver.”  Seniors who would otherwise need nursing home care, but who can have their needs met at home can obtain a wide variety of government financed care support.  Professionals seeking information on the services that can be authorized under the program may consult Appendix C of the Waiver application.  Consumers should contact their local Area Agency on Aging for more information. 

To qualify for no cost Aging Waiver services the applicant must meet Medicaid’s stringent financial and functional need requirements.  Elder law attorneys like Marshall, Parker & Associates show their clients how to use legal planning techniques to help them qualify. 

The eligibility requirements for Medicaid funded Aging Waiver are somewhat more restrictive than for nursing facility care. In addition to meeting all of the Medicaid financial and non-financial rules for nursing facility care the applicant must have income below 300% of the federal poverty standard. The Aging Waiver program imposes the same level of care requirements as for nursing facility services. In order to qualify for PDA waiver benefits, an applicant must be determined to require the level of care of a nursing facility. 

The Pennsylvania Department of Aging, which formerly administered the Aging Waiver, no longer oversees its operation. That function has been taken over by the Office of Long Term Living (OLTL).  Aging Waiver enrollment and Level of Care determinations will continue to take place through the local Area Agencies on Aging (AAAs) but with direct oversight by OLTL. Services are provided through qualified providers that are enrolled as Medical Assistance providers.  

Federal law gives individuals who are denied Aging Waiver services or the provider of their choice the right to request a Fair Hearing under 42 CFR §431 Subpart E. The same hearing rights apply if a Waiver recipient’s services are suspended, reduced or terminated.

The federal government approval of Pennsylvania’s Aging Waiver is limited in time.  Each five years Pennsylvania must seek federal approval to renew this waiver.  Pennsylvania’s previous approval expired on June 30, 2008 and it filed an application for another five year renewal. This application was initially denied but federal approval has now been received. 

A copy of the approved Aging Waiver is available on the Marshall, Parker & Associates website at www.paelderlaw.com/pdf/Aging_Waiver_Renewal.pdf.  The renewed Aging Waiver includes a number of significant changes from the prior program.  Among the many changes being made to the program:  

  -     Implementation of a comprehensive Quality Management strategy that requires more effective monitoring of local agency operations.

  -   Refinement of waiver service definitions and development of a standard statewide rate-setting process, including the addition of case management as an Aging Waiver Service;

-   Design of a new  "Services My Way" Pilot (Cash and Counseling model);

-    Examination of the process used for Level of Care (LOC) determinations to maximize statewide consistency and appropriateness

-    Consideration of policies that would allow for Payment to Spouses as Personal Assistance Service Workers, and

-Implementation of “TeleCare” which involves phone and electronic health status measuring and monitoring services, medication dispensing and safety monitoring.

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