State Plan Personal Care: Assistance with Day-to-Day Activities through Arkansas’ Medicaid

Last updated: March 21, 2024

 

Overview of Arkansas Medicaid State Plan Personal Care

Arkansas’ State Plan Personal Care, which may be thought of as a Personal Care Program, provides personal care services for AR residents who are elderly or physically disabled and require assistance with day-to-day activities. Intended to prevent and delay nursing home admissions, the assistance provided by personal care aides enable persons to continue to live in their own home. Specifically, assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is provided. These activities include bathing, dressing, mobility, meal preparation, eating, laundry, and light housecleaning.

Personal care services offered under this program may be provided by licensed agency workers or program participants have the option to self-direct their own care via a program called Independent Choices / IndependentChoices. Persons are allotted a cash allowance with which to purchase personal care services (and goods that reduce the need for personal care assistance). This allows them to hire, train, and manage the personal care aide of their choosing. Friends and relatives, such as an adult child, can be hired, but spouses and legal guardians are prohibited from being hired. A financial management service (FMS) agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.

Program participants can live in their own home, the home of a friend or relative, a residential care facility, or a level I assisted living facility. (Level I assisted living facilities do not provide nursing services, while level II assisted living facilities do). Persons who require level II assisted living should consider another AR Medicaid program, the Living Choices Assisted Living Waiver. It is also thought that persons can reside in adult family homes (adult foster care).

Arkansas State Plan Personal Care is available through the state’s Regular Medicaid program. Personal care services via this program are an entitlement; meeting the eligibility requirements guarantees one will receive benefits. Self-directed personal assistance services, available via Independent Choices, is a 1915(j) State Plan Option. Medicaid in Arkansas is also called “Health Care”.

 Medicaid Waivers versus State Plan / Regular 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 have been filled, a waitlist for benefits begins. 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 State Plan Personal Care

With State Plan Personal Care, up to approximately 14.75 hours / week of personal care assistance may be provided. This may include assistance with the following activities.

– Bathing
– Dressing
– Eating
– Housekeeping
– Laundry
– Meal Preparation
– Personal Hygiene – grooming, shampooing, brushing hair, skin care, shaving, oral care
– Shopping for Essential Items – i.e., food and clothing
– Taking Medication(s)
– Toiletry
– Mobility / Ambulation – moving from one location / position to another

While program participants can reside in level I assisted living facilities, and it is thought they can reside in adult family homes, the cost of room and board is not covered.

 

Eligibility Requirements for Arkansas’ State Plan Personal Care

State Plan Personal Care is for Arkansas residents of all ages who are eligible for Arkansas’ State Medicaid Plan. The criteria below is relevant for the elderly (65+ years of age).

 The American Council on Aging provides an online Medicaid Eligibility Test for AR seniors. Start here

 

Financial Criteria: Income, Assets & Home Ownership

Income
Effective 4/1/24 – 3/31/25, the individual applicant income limit is $1,004 / month. Married couples, regardless of if one or both spouses are applicants, can have a monthly income up to $1,362.67.

 While 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, this is not an option with AR State Plan Personal Care. In contrast, Arkansas’ ARChoices in Homecare Program does allow 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 $9,430 for a single applicant. For married couples, the asset limit is $14,130. This hold true whether one or both spouses 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.

While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, it is not relevant for State Plan Personal Care. In other words, the Look-Back Period is not applicable.

Note: In Arkansas, individuals eligible for SSI are automatically eligible for Medicaid. This pathway to eligibility allows a single senior to have income up to $943 / month and assets up to $2,000. A married couple can have income up to $1,415 / month and assets up to $3,000.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our 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 their home. Fortunately, for eligibility purposes, Arkansas Medicaid considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has “Intent” to Return home, 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.
– A spouse lives in the home.
– The applicant has a minor child living in the home.
– The applicant has a disabled relative living in the home.

Learn more about the potential of Medicaid taking the home.

 

Medical Criteria: Functional Need

While many Medicaid long-term care programs require an applicant to have a Nursing Facility Level of Care (NFLOC) need, State Plan Personal Care does not. It does, however, require that the need for assistance be medically necessary. This is demonstrated by the need for hands-on assistance with at least one of the following Activities of Daily Living (ADL): bathing, personal hygiene, dressing, toileting, eating, and ambulating.

The Arkansas Independent Assessment (ARIA), which consists of more than 300 questions, is the tool used to assist in determining one’s functional need. A registered nurse employed by an Independent Assessment Contractor completes this assessment, and as part of the assessment process, a tier level between 0 and 3 is assigned. Tier 0 indicates that hands on assistance is not required, and therefore, one does not meet the functional need for State Plan Personal Care . Tiers 1 and 2 indicate that hands on assistance is required and one meets the functional need. Tier 3 also indicates one requires hands on assistance, but their needs are too great for State Plan Personal Care. ARIA results are reviewed by a nurse from AR’s Department of Human Services who makes the final level of care determination.

While a diagnosis of Alzheimer’s disease or a related dementia does not mean one will automatically meet the level of care need, it is common for persons with dementia to require assistance with ADLs.

 Learn more about long-term care Medicaid in Arkansas.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for 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.

While Arkansas has a Spenddown Program that permits Medicaid applicants to spend “excess” income on medical expenses in order to meet Medicaid’s income limit, it is prohibited for persons to qualify for State Plan Personal Care via this avenue.

When persons have assets over the limits, one option is to “spend down” excess assets. Examples include paying off debt, making home improvements, such as updating heating and plumbing, and purchasing pre-paid funeral and burial expense trusts called Irrevocable Funeral Trusts. A Medicaid-Compliant Annuity, which takes a lump sum of assets and converts them into an income stream, also can lower countable assets. There are many other options 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 AR Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Arkansas to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while it is thought Medicaid’s 60-month Look Back Rule does not apply to State Plan Personal Care, it does apply to nursing home Medicaid and other long-term care Medicaid programs (i.e., ARChoices in Homecare and the Assisted Living Waiver). As more extensive Medicaid-funded care might be required in the future, it is vital that one does not violate the look back rule. Medicaid Planning strategies should ideally only be implemented with careful planning and well in advance of the need for long-term care. 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 Arkansas Medicaid State Plan Personal Care

Before You Apply

Prior to applying for State Plan Personal Care, applicants need to ensure they meet the Arkansas Medicaid 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, previous bank statements, proof of income, copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.

 

Application Process

To apply for State Plan Personal Care, persons need to first be eligible for AR Medicaid. To apply, persons should contact their local Department of Human Services (DHS) office. Alternatively, persons can call the Division of Medical Services’ Help Desk at 800-482-8988 to request an application.

Once one is enrolled in Medicaid, personal care services must be authorized by one’s physician. A functional assessment will be completed as part of the eligibility process for personal care assistance.

Although not intended for a consumer audience, additional information about AR State Plan Personal Care can be found here.

The Arkansas Department of Human Services (DHS) administers the state’s Medicaid program through which State Plan Personal Care is provided. Independent Choices is operated by the DHS Division of Provider Services and Quality Assurance (DSPQA).

 

Approval Process & Timing

The Arkansas 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 even further. 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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