Medicaid-Funded In-Home Personal Care Assistance for Alaska Seniors

Last updated: February 17, 2024

 

Overview of Alaska Medicaid Personal Care Services Program

Alaska’s Personal Care Services Medicaid program, or PCS Program, provides state residents who are elderly or disabled with in-home assistance. Intended to assist program participants in living independently, they receive help with completing their daily living activities. This includes activities such as bathing, dressing, toileting, mobility, meal preparation, eating, light housecleaning, and shopping for essentials.

Program participants can live in their own home or that of a loved one. Services cannot be provided for persons living in an assisted living residence, and Alaska does not offer adult foster care homes. Persons interested in assisted living services should consider the Alaskans Living Independently Medicaid Waiver program.

The services offered under the PCS Program may be provided by licensed agency workers via the Agency Based Personal Care Services Program, or program participants have the option to self-direct their care. The participant-directed option, specifically called the Consumer Directed Personal Care Services Program (CDPCS), allows one to hire, train, supervise, and even fire, the “personal care assistant” of their choosing. Friends and relatives, such as one’s adult child, can be hired, given they pass a background check and complete the required training. One’s spouse is prohibited from being hired. A Consumer Directed Provider Agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.

The Personal Care Services (PCS) Program is available through the state’s Regular Medicaid program. This program was previously called the Personal Care Assistance Program, or PCA Program. PCS are an entitlement. This means meeting the state’s Medicaid eligibility requirements guarantees one will receive assistance; there is never a waiting list for program participation.

 Medicaid Waivers vs. State Plan Medicaid
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. This means meeting the program’s eligibility requirements guarantees an applicant will receive benefits. HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they are filled, a waitlist for benefits forms. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.

 

Benefits of the Personal Care Services Program

The activities with which assistance can be provided include the following.

– Bathing / Showering
– Bed Mobility
– Dressing / Undressing
– Eating / Drinking
– Escorting – to medical / dental appointments
– Laundry
– Light Housecleaning
– Locomotion – i.e., walking from one location to another in one’s home
– Meal Preparation / Cleanup
– Medication Administration
– Passive Range of Motion Exercises
– Personal Hygiene (i.e., hair, nail, skin, and teeth care)
– Shopping for Essentials
– Toileting
– Transferring – i.e., from a bed to a wheelchair
– Tube Feeding – only available to persons who are self-directing their care
– Wound Care / Dressing Changes

 

Eligibility Requirements for Alaska’s Personal Care Services Program

PCS are for Alaska residents 6 years of age and older who, due to a physical condition, require assistance with their daily living activities. Additional eligibility criteria follows and is relevant for seniors.

 The American Council on Aging provides a quick and easy Medicaid Eligibility Test for AK seniors.

 

Financial Criteria: Income, Assets & Home Ownership

Income
In 2024, the individual applicant income limit is $1,751 / month. For a married applicant, regardless of if one spouse or both spouses is an applicant, the income limit is $2,593 / month.

 Many home and community based services Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets. Alaska’s State Plan Personal Care Services Program does not. However, the Alaskans Living Independently Medicaid Waiver, which offers a variety of long-term services and supports, allows a non-applicant spouse a Monthly Maintenance Needs Allowance from their applicant spouse and a Community Spouse Resource Allowance.

Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, it is $3,000, regardless of whether one spouse or both are applicants.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Medicaid Spend Down Calculator.

 

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, Medicaid in AK considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor child (under 21) living in the home.
– The applicant has a blind or disabled child of any age living in the home.

Learn more about the potential of Medicaid taking the home.

 Alaska also has another Medicaid program through which personal care services are available. This is the Community First Choice Program. While this program, unlike the Personal Care Services Program, requires a Nursing Facility Level of Care (NFLOC), additional benefits, such as skills training to learn to do daily activities more independently, are available.

 

Medical Criteria: Functional Need

An applicant must require assistance with at least one Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL). These activities include bed mobility, locomotion (i.e., moving from the bedroom to the kitchen), transferring (i.e., moving from the bed to a chair), dressing, eating, bathing, toileting, meal preparation, routine housework, medication administration, laundry, and shopping. The tool used to determine if one meets this functional criteria is the Consumer Assessment Tool (CAT). While persons with Alzheimer’s Disease or a related dementia can meet the functional need, a diagnosis in and of itself does not mean one will automatically qualify.

 Learn more about long-term care Medicaid in Alaska. 

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for AK Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

Utilizing Miller Trusts, often called Qualified Income Trusts, is a common strategy used to lower an applicant’s monthly countable income for long-term care Medicaid eligibility. Essentially, “excess” income is deposited into the trust, no longer counting as income. Miller Trusts, unfortunately, are not permitted for applicants to become income-eligible for Alaska’s Personal Care Services Program.

When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons may also choose to “spend down” countable assets on ones that are exempt (non-countable). Examples include making home reparations and modifications, purchasing home furnishings, and even taking a vacation. There are many other Medicaid planning strategies available when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Alaska to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.

 

How to Apply for Alaska Medicaid Personal Care Services Program

Before You Apply

Prior to applying for the PCS Program, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.

 

Application Process

Persons begin the application process for the Personal Care Services Program by contacting a Personal Care Services agency to complete a Personal Care Services Initial Application. Contact information for agencies that service the PCS Program can be found here by clicking on the “Resource Directory”. The directory contains agencies that service several Medicaid programs, so be sure to check that PCS / PCA is named as a program under an agency before contacting them.

As part of the application process, a nurse from the Division of Senior & Disabilities Services will complete an in-home functional needs assessment.

Learn more about the Personal Care Services Program here. This program is administered by the Alaska Department of Health’s PCS Unit within the Division of Senior and Disabilities Services (SDS).

 

Approval Process & Timing

The Alaska Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.

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