Paying for Personal Assistance Services

Most people either pay for Personal Assistance Services with their own money or with the support of a Medicaid waiver. First we’ll explain how you may be able to get a Medicaid waiver to pay for your services. Then we’ll describe the additional duties you’ll have if you are paying for services on your own.

Medicaid Waivers

In Georgia, Personal Assistance Services (PAS) are not covered by regular Medicaid. However, Georgia has four Medicaid waiver programs, which offer extra benefits and services to people who qualify that let them live safely in their own homes. Personal Assistance Services, also called Personal Support Services and Community Living Support, are one of these extra services.

Exception: Children under 21 who have regular Medicaid can have PAS covered by their plan, and do not need a waiver.

Eligibility

To qualify for one of Georgia’s Medicaid waiver programs, you must:

• Need a level of care normally provided by a hospital, nursing home, or other care facility
• Have resources that are $2,000 or less if you are single ($3,000 or less for couples), and
• Have income that is $2,901 or less a month.

For all waiver programs, you must need help to do regular daily activities, such as eating, toileting, dressing, or moving around, in order to live in a house or apartment in the community instead of in an institution. Each waiver program supports people with different situations or conditions, so they also have their own extra eligibility rules. Not all people with disabilities qualify for waivers.

Some waiver programs have waiting lists, which means you won’t get services right away. Note: If you’re on the waiting list for the New Options Waiver Program (NOW) or the Comprehensive Support Waiver Program (COMP), which are for people with intellectual and developmental disabilities, you should apply for Family Support Services, which may be able to provide some personal care services and other help.

To learn more about Georgia’s Medicaid waiver programs and how to apply, read DB101’s Medicaid waiver article.

Getting PAS through a Medicaid Waiver

Once you are approved for a waiver, a case manager will work with you to decide which services you need. Depending on your situation, you may qualify to get Personal Assistance Services.

If you need PAS, Medicaid will pay for a certain number of hours of personal assistance each week, with the exact amount depending on your needs. For example, if you just need a bit of help a few times per week, Medicaid might pay for just five hours per week of assistance. However, if you need a lot of help every day, Medicaid could pay for 40 hours per week of assistance.

The Services You Can Get

The Personal Care Assistant (PCA) you get through a Medicaid waiver can help you with various things:

• Personal care services, such as eating, bathing, grooming, dressing, toileting, walking or using a wheelchair, using a phone, and help with medications
• Domestic services, such as sweeping, vacuuming, taking out the garbage, wheelchair cleaning and battery recharging, and changing bed linens
• Related services, such as meal preparation, clean-up, laundry, and shopping
• Limited heavy cleaning, such as mopping floors

These services can let you live in your own home or apartment, giving you the support you need to continue living independently.

What You Pay

The Medicaid waiver program will pay for most of the cost of your Personal Assistance Services. However, depending on your income, you may have to pay part of the cost.

If you need more hours of personal assistance than your waiver program will pay for, you will have to pay for them yourself.

Your Responsibilities

You, or your representative, will need to make sure that your PCA does what you need. If you choose to self-direct your personal support services and hire a PCA yourself, you may have additional responsibilities, such as:

• Creating the PCA’s schedule
• Making a backup plan if the PCA can’t come as planned
• Training your PCA
• Supervising your PCA
• Firing your PCA if you are not satisfied with their work

If You Are Paying for Services on Your Own

If you are paying for services on your own, either because you do not have a Medicaid waiver or because you need more hours than Medicaid will offer, you have the same two basic options that are described above:

1. You can hire a PCA through an agency
2. You can hire a PCA on your own

If you hire a PCA through an agency, the agency will help you find an assistant who knows how to do the tasks you need help with. A couple of big advantages of hiring through an agency is that the PCAs have already been trained and if you need a substitute PCA for any reason—for example, if your regular PCA is ill—the agency can provide you with one.

If you hire a PCA on your own, you will have the most flexibility, but also the greatest responsibility. You will have to handle not only all hiring, training, supervision, and possible firing of the attendant, but also all paychecks and tax withholdings. Still, for many people this works best because they get to hire somebody they really know and trust.