There are several steps in the Waiver application process:
Determination that someone meets the level of care requirement and functional criteria:
An in-person assessment is completed to determine whether someone meets the level of care requirement and other functional criteria. Sometimes, these are two different assessments done by two separate agencies. As part of the assessment process, the individual’s physician completes paperwork to certify the level of care needed by the person applying for the Waiver program.
Determination of financial eligibility: Once the above steps are completed and the person appears to meet the functional criteria and level of care requirement, then the application is sent to the County Assistance Office (CAO). The CAO reviews the person’s income and resources to see if they qualify financially for the Waiver program.
Alternatively, Medicaid planning professionals can work with a family to arrange their assets and income into annuities and trusts so that they meet the eligibility requirements. For example, by pre-funding a funeral using an irrevocable funeral trust, one can reduce their countable assets by up to $15,000.
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The income limit for an individual applying for a PA Medicaid waiver is $2,199 / month. If one spouse is applying for Medicaid and the other is not, joint income can be shifted to help the applicant qualify. The maximum monthly income a non-applicant spouse can have is $2,980.50.
The asset limit for the PDA waiver is $8,000. Resources in excess of that amount will need to be spent down or re-allocated into exempt (non-countable) assets. When one spouse of a married couple is applying, resources in excess of $8,000, up to a maximum of $119,220 can be allocated to the non-applicant spouse. This is referred to as the Community Spouse Resource Allowance.
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To be eligible for the Aging Waiver, you must:
There is no cap on the services that Aging Waiver participants receive, no cost sharing and no contributions allowed.