Idaho Health Plan Coverage (Medicaid) State Plan Personal Care Services (PCS)

Last updated: February 28, 2024

 

Overview of Idaho’s State Plan Personal Care Services

Idaho’s State Plan Personal Care Services (PCS), also called the Personal Care Services Program, is a statewide Medicaid program that provides in-home assistance for persons who are aged and disabled. Intended to prevent unnecessary nursing home admissions, a “personal assistant” provides program participants assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). This includes activities such as bathing, grooming, dressing, toileting, meal preparation, shopping for essentials, and laundry.

Program participants can reside in their own private home or that of a loved one. In some cases, persons who live in certified family homes (adult foster care homes) or assisted living residences may be eligible to receive PCS. However, they must be paying privately and cannot be a recipient of any other Medicaid-funded personal care services.

Many long-term care Medicaid programs offer a self-directed option, allowing program beneficiaries to hire their own caregiver. Idaho’s Personal Care Services Program does not. Instead, personal care assistance is provided by licensed personal assistants employed by Personal Assistance Agencies.

State Plan Personal Care Services is part of Idaho’s Regular State Plan Medicaid. Medicaid in Idaho is also called Idaho Health Plan Coverage. Relevant for seniors 65+ years of age, the Medicaid program is called Aid to the Aged, Blind, and Disabled (AABD). PCS are an entitlement; meeting eligibility requirements ensures one will receive services. This means there is never a waiting list to receive personal care services.

 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. Put differently, meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, 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 Idaho’s State Plan Personal Care Services

Program participants can receive up to 16 hours per week of personal care services. The exact activities with which one receives assistance is based on an individualized care plan. Assistance may be provided with the following activities.

– Bathing
– Changing Bed Sheets
– Dressing
– Eating
– Hair Care
– Laundry
– Meal Preparation
– Prescription Medication Assistance
– Shopping for Essentials – i.e., groceries
– Skin Care
– Toileting
– Transportation Accompaniment – to medical appointments

Independence training with activities, such as dressing and grocery shopping, is also available for program participants who are developmentally disabled.

 

Eligibility Requirements for Idaho’s State Plan Personal Care Services

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

PCS is for ID residents who are elderly and disabled. The following criteria is relevant for seniors aged 65 and over.

 

Financial Criteria: Income, Assets & Home Ownership

Income
The income limit for a single applicant is $996 / month. When an applicant is married, regardless of whether or not their spouse is also an applicant, there is a couple income limit of $1,435 / month.

 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, Idaho’s Personal Care Services Program does not. In contrast, Idaho’s Aged and Disabled Waiver 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 for a single applicant is $2,000. For married applicants, with one or both spouses as applicants, the asset limit is $3,000.

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 Idaho’s Personal Care Services Program.

 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 it. Applicants for Idaho’s State Plan Personal Care Services need not worry. As long as they live in their home, it is exempt (non-countable). However, if they live outside of their home, they must have Intent to Return home in order for it to remain exempt. It is important to note that other Idaho Medicaid programs, such as the Aged and Disabled Medicaid Waiver and Nursing Home Medicaid, have additional requirements for home exemption. Learn more here.

 

Medical Criteria: Functional Need

Many Medicaid long-term care programs require an applicant need a Nursing Facility Level of Care (NFLOC), but this is not the case for Idaho’s State Plan Personal Care Services Program. The need for care, however, must be “medically necessary”. The Uniform Assessment Instrument (UAI) is used to help make this determination. An inability to complete one’s Activities of Daily Living and Instrumental Activities of Daily Living is generally indicative of assistance being “medically necessary”. These activities include bathing, dressing, grooming, toileting, transferring (i.e., from a chair to standing), mobility, eating, laundry, meal preparation, and light housecleaning. While it is common for persons with Alzheimer’s Disease or a related dementia to meet the level of care need, a diagnosis of dementia in and of itself does not mean one will automatically be functionally eligible.

Learn more about long-term care Medicaid in Idaho.

 Idaho’s Aged and Disabled Medicaid Waiver provides a greater variety of home and community based services to assist seniors in living independently. In addition to providing care services in certified family homes and assisted living residences, benefits may include adult day care, home modifications, personal emergency response systems, home meal delivery, skilled nursing, and respite care. While this Waiver program allows applicants a higher level of income, they must require a Nursing Home Level of Care. Furthermore, unlike State Plan Personal Care Services, it is not an entitlement program.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for ID Medicaid. There are a variety of Medicaid 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 Idaho’s State Plan Personal Care Services.

When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts (IFTs) are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts (MAPTs) are another option, as assets in this type of trust are not counted. Another option are Medicaid-Compliant Annuities that turn countable assets into a stream of income. 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 the state of Idaho to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while Medicaid’s 60-month Look-Back Rule does not apply to Idaho’s Personal Care Services Program, some persons will require more extensive care in the future, such as home and community based services via a Medicaid Waiver or Nursing Home Medicaid. For these programs, the Look Back Rule is relevant, and violating it results in a Penalty Period of Medicaid ineligibility. While there are many Medicaid planning strategies, they should 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 Idaho’s State Plan Personal Care Services

Before You Apply

Prior to applying for Idaho’s 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, prior bank statements, 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 can apply for Idaho’s State Plan Personal Care Services online at idalink, over the phone at 877-456-1233, or in-person at one’s local DHW office. Furthermore, an Application for Health Coverage Assistance can be downloaded here and submitted per instructions on the application.

The Idaho Medicaid Provider Handbook, although not intended for a consumer audience, contains additional information about ID’s State Plan Personal Care Services.

The Bureau of Long Term Care (BLTC) within the Idaho Department of Health and Welfare (IDHW) administers the Personal Care Services Program.

 

Approval Process & Timing

The Medicaid application process in Idaho 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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