Overview of MaineCare’s Consumer Directed Attendant Services
Maine’s Consumer Directed Attendant Services Program provides in-home personal care assistance for adults and seniors who are chronically or permanently disabled. The term, “disabled” is used loosely, as eligibility is not determined based on specific diagnoses, but rather, it is based on functional need for assistance. This means that a senior could potentially have arthritis or another age related issue and be eligible. Consumer Directed Attendant Services are intended to assist program participants in living independently in their homes. Activities with which one might receive assistance include bathing, personal hygiene, dressing, mobility, preparing meals, laundry, and light housecleaning. Furthermore, assistance with health maintenance activities, like ostomy care, medication administration, and catheterization may be provided.
Program participants can live in their own home or that of a loved one. They cannot live in an adult family care home (adult foster care home) or an assisted living residence.
Indicative by the program name, Consumer Directed Attendant Services, program participants self-direct their own care. With consumer-directed care, program participants become the employer, giving them the responsibility of hiring, training, managing, and even firing their own caregiver. This includes the ability to hire a friend or select relatives. While it is possible to hire one’s adult child, a spouse or a legally responsible relative cannot be hired. A fiscal intermediary handles the financial aspects of employment responsibilities, such as background checks, tax withholding, and caregiver payments.
The Consumer Directed Attendant Services Program is available through Maine’s Regular State Plan Medicaid (MaineCare) program. These services are an entitlement. This means meeting the state’s Medicaid eligibility criteria guarantees one will receive assistance; there is never a waiting list for program participation.
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. On the other hand, 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 MaineCare’s Consumer Directed Attendant Services
The services for which one can receive assistance, and the hours of assistance provided, is determined based on an individualized care plan. Potential benefits include the following.
– Care Coordination – up to 18 hours / year.
– Skills Training – up to 14.25 hours / year. Provides training relative to managing one’s personal care services (i.e., how to hire, train, manage, and fire one’s caregiver).
– Personal Care Services – up to 28 hours / week. These services include Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). This includes bathing, dressing, personal hygiene (i.e., combing hair, shaving, brushing teeth), toiletry, mobility, transferring (i.e., from bed to chair), routine housework (i.e., sweeping, vacuuming, changing bed linens), laundry, meal preparation / clean up, eating, grocery shopping, and money management. Assistance with health maintenance tasks (i.e., physical therapy activities, tube feeding preparation, medication administration) also falls under personal care services.
Eligibility Requirements for MaineCare’s Consumer Directed Attendant Services
Consumer Directed Attendant Services is for ME residents who are 18+ years old. Additional eligibility criteria follows.
Financial Criteria: Income, Assets & Home Ownership
In 2023, the individual applicant income limit is $1,215 / month. For a married couple, regardless of if one spouse or both spouses are applicants, the income limit is $1,644 / month.
In 2023, the asset limit is $10,000 for a single applicant. For married couples, it is $15,000, 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.
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 does not apply to Maine’s Consumer Directed Attendant Services Program.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Applicants for the Consumer Directed Attendant Services Program need not worry. As long as they live in their home, the home is exempt (non-countable). However, if they live in a relative’s home, they must have Intent to Return home in order for it to remain exempt. It is important to note that other MaineCare programs, such as the Elderly and Adults with Disabilities Waiver and Nursing Home Medicaid, also have a home equity interest limit for home exemption. Learn more about home exemption and when Medicaid can and cannot take the home here.
Medical Criteria: Functional Need
While many Medicaid long-term care programs require an applicant to need a Nursing Facility Level of Care (NFLOC), the Consumer Directed Attendant Services Program does not. The need for assistance, however, must be “medically necessary”. To make this determination, a registered nurse completes the Medical Eligibility Determination (MED) Form. The ability / inability to complete the following Activities of Daily Living (ADLs) are considered: bed mobility, locomotion, transferring, toiletry, bathing, dressing, and eating. The minimal requirement for functional eligibility is that one require limited assistance, including physical assistance, with a minimum of 2 of the above ADLs.
Persons must be cognitively able to self-direct their own care. Cognitive capacity, such as decision making skills, the ability to be understood, and the ability to understand others, is also considered during the MED. While persons with Alzheimer’s disease or a related dementia might meet the functional need for care, if they are not able to direct their own care, they will be ineligible for Consumer Directed Attendant Services.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for ME 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.
Maine has a Medically Needy pathway to eligibility for Medicaid applicants who have high medical expenses relative to their income. Also known as a Spend-Down Program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s Medically Needy income limit. The amount that must be “spent down” can be thought of as a deductible. Once one’s “deductible” has been met, the Consumer Directed Attendant Services Program will pay for care services and supports.
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 assets that Medicaid considers to be exempt (non-countable). Examples include making home reparations and modifications, purchasing home furnishings, and even taking a vacation. Medicaid-Compliant Annuities are another option in which a lump sum of cash is converted into a monthly income stream. There are many other 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 Maine to meet Medicaid’s financial eligibility criteria without jeopardizing MaineCare eligibility. Furthermore, while Medicaid’s 60-month Look Back Rule does not apply for Consumer Directed Attendant Services, it applies to nursing home Medicaid and the Elderly and Adults with Disabilities Waiver. Since more extensive Medicaid-funded care might be required in the future, it is vital that one 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 MaineCare’s Consumer Directed Attendant Services
Before You Apply
Prior to submitting an application for Consumer Directed Attendant Services, 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, previous 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.
To be eligible for the Consumer Directed Attendant Services Program, an applicant must be eligible for MaineCare (Medicaid in Maine). Persons can apply online at My Maine Connection, by calling the Office for Family Independence at 855-797-4357, or in-person at one’s district Department of Health and Human Services office. An Application for Benefits can be found here.
Persons enrolled in MaineCare should contact Maximus, the state’s Assessing Agency, to request a Medical Eligibility Determination (functional assessment). They can be reached at 833-525-5784.
Additional information about the Consumer Directed Attendant Services Program, although not necessarily intended for a consumer audience, can be found here in Section 12.
The Consumer Directed Attendant Services Program is administered by Maine’s Department of Health and Human Services (DHHS) and it is operated by the Office of Aging and Disability Services (OADS). The Office of Family Independence (OFI) determines financial eligibility. An Assessing Services Agency determines functional eligibility.
Approval Process & Timing
The MaineCare (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.