Personal Choices Program

Overview of the Personal Choices Program

The Medicaid Personal Choices Program is a program that allows individuals who are eligible for Medicaid and require long-term care to manage their care services. Through this program, individuals can receive a monthly budget for needed services and have the flexibility to hire their caregivers, including friends and family members. The program aims to give people more control over the type of care they receive and how it is delivered.

Here are some of the main components of the Medicaid Personal Choices Program:

1. Self-Directed Care: Participants in the program can hire and manage their care attendants, including hiring friends or family members to provide care.
2. Budgets: Participants receive a monthly budget to spend on care services. The budget is based on the individual's needs and is intended to cover the cost of services and support.
3. Support Services: Participants can receive support in managing their care through counseling and training. They also have access to a financial management service that helps them manage their budget and pay for services.
4. Service Plan: Participants work with a counselor to develop a personalized plan for care services. This plan outlines the types of services needed, the budget for these services, and how they will be delivered.
5. Variation by State: The Personal Choices Program can vary by state, as Medicaid programs are administered at the state level. Different states may have other names for similar programs, additional eligibility criteria, and different services available through the program.

This program is part of a broader movement towards consumer-directed care, which aims to give individuals more control over the healthcare services they receive. The Personal Choices Program is just one example of how this can be implemented for individuals who are eligible for Medicaid and need long-term care.

Alternate names for the Personal Choices Program

The Personal Choices Program may also be known by different names depending on the state or region. Here are a few alternative names that may be used to refer to similar programs:

1. Consumer-Directed Services Program
2. Self-Directed Services Program
3. Participant-Directed Services Program
4. Cash and Counseling Program
5. Individual Budget Program
6. Participant-Employed Provider Program
7. Home and Community-Based Services (HCBS)

Eligibility requirements

Eligibility for the Medicaid Personal Choices Program or similar Medicaid waiver programs is determined based on income, assets, level of care needed, and state-specific criteria. Below are some common criteria:

1. Income Limits: Each state sets its income limits for Medicaid eligibility. Generally, individuals must have an income that is at or below a certain percentage of the Federal Poverty Level (FPL). Some states allow individuals with income above the standard Medicaid limits to qualify for the program through "spend-down" provisions or special income trusts.
2. Asset Limits: Individuals must also meet asset limits. This includes checking and savings accounts, investments, and in some cases, property. Some assets, like your primary home or a car, may be exempt.
3. Level of Care: To qualify for the Personal Choices Program or a similar program, an individual must typically require a level of care equivalent to that provided in a nursing home. This is assessed based on the individual's ability to perform activities of daily living such as bathing, dressing, eating, etc.
4. Disability Status: Many Medicaid waiver programs, including Personal Choices, are designed for individuals with disabilities. States may have specific criteria for what constitutes a disability.
5. Age: Some programs are specifically for elderly individuals, typically those aged 65 and older, while others are for individuals with disabilities of any age.
6. Citizenship or Immigration Status: To qualify for Medicaid, individuals must be U.S. citizens or have eligible immigration status.
7. State Residency: Individuals must be residents of the state where they apply for Medicaid.
8. Other State-Specific Criteria: States may have additional criteria for eligibility.

Application Process

1. Determine Eligibility: Before applying, individuals can use online pre-screening tools or contact their state's Medicaid office to determine if they may be eligible for the program.
2. Complete Application: Individuals can apply for Medicaid online, by mail, or in person at their local Medicaid office. Some states have specific application forms for waiver programs like Personal Choices.
3. Gather Documentation: Applicants must provide documentation of their income, assets, medical condition, and any other information their state requires.
4. Assessment: After the application is submitted, the state may require an evaluation to determine the level of care needed. This is typically done in the applicant's home.
5. Approval and Enrollment: Individuals will be enrolled in the program once approved. If enrolling in a program like Personal Choices, they will work with a counselor to develop a care plan.
6. Regular Reviews: Once enrolled, participants will typically be subject to periodic reviews to ensure they continue to meet the eligibility criteria.

Because eligibility criteria and application processes vary by state, individuals must contact their local Medicaid office or visit their state's Medicaid website for the most accurate and up-to-date information.

Where is the Personal Choices Program available?

The Medicaid Personal Choices Program and similar programs are available in various states across the United States. Here is a list of states and the names of the programs or waivers that provide Home & Community Based Services:

‍Alabama

• Elderly and Disabled (E&D) Waiver
• Alabama's Community Transition (ACT) Waiver
• State of Alabama Independent Living (SAIL) Waiver

Alaska

• Alaskans Living Independently (ALI) Waiver
• Community First Choice (CFC) Program
• Personal Care Services (PCS) Program

Arizona

• Arizona Long-Term Care System (ALTCS) Agency with Choice

Arkansas

• ARChoices in Homecare Waiver
• Living Choices Assisted Living Waiver
• Personal Care Program

California

• In-Home Supportive Services (IHSS) Program
• Assisted Living Waiver (ALW)
• Multipurpose Senior Services Program (MSSP)
• Home and Community-Based Alternatives (HCBA) Waiver
• Community-Based Adult Services (CBAS) Program
• Enhanced Care Management Benefit

Colorado

• Elderly, Blind & Disabled Waiver CDASS & IHSS

Connecticut

• Community First Choice (CFC) Program
• Connecticut Home Care Program for Elders (CHCPE)

District of Columbia

• Elderly and Persons with Physical Disabilities (EPD) Waiver
• State Plan Personal Care Aide Services Program
• Adult Day Health Program (ADHP) Services

Delaware

• Diamond State Health Plan Plus (DSHP-Plus) Program
• Elderly and Disabled Home and Community-Based Waiver Program

Florida

• Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) Program

Georgia

• Elderly and Disabled Waiver Program (formerly known as the Community Care Services Program (CCSP))
• Services Options Using Resources in Community Environments (SOURCE)

Hawaii

• QUEST Integration (QI) Program

Idaho

• Medicare Medicaid Coordinated Plan (MMCP)
• Idaho Medicaid Plus (IMPlus)
• Aged & Disabled (A&D) Waiver
• Personal Care Services (PCS) Program

Illinois

• Supportive Living Program (SLP)
• HCBS Waiver for Persons who are Elderly
• HealthChoice Illinois / Managed Long-Term Services and Supports (MLTSS)
• Medicare-Medicaid Alignment Initiative (MMAI)

Indiana

• Aged and Disabled (A&D) Waiver

Mississippi

• Elderly and Disabled Waiver 

This list provides information about programs available as of September 2022. It's essential to consult the specific Medicaid office or official documentation for each state or district to understand the services and options available under their respective waivers.

Compensation for caregivers

Many Medicaid waiver programs, including the Personal Choices Program, allow for the compensation of family caregivers. This is often referred to as "consumer-directed care" or "self-directed care," and it enables individuals eligible for Medicaid to have greater control over their care services, including the ability to hire family members as caregivers.

To be compensated as a family caregiver, the following steps and requirements are typically involved:

1. Eligibility of the Care Recipient: The care recipient must be eligible for Medicaid and enrolled in a waiver program that allows for self-directed care, such as the Personal Choices Program.
2. Care Plan: The recipient must work with a counselor or care manager to develop a care plan. This plan should outline the needed services and identify the family member providing care.
3. Caregiver Requirements: Family caregivers may need to meet specific requirements, such as undergoing background checks or completing training programs. These requirements vary by state.
4. Documentation and Reporting: Caregivers must typically keep records of their care, including hours worked and the types of services rendered. These records must be submitted regularly for review.
5. Payment: Payment rates for family caregivers vary by state and program. In some cases, the care recipient receives a budget and is responsible for paying the caregiver from this budget. In other cases, the Medicaid program may pay the caregiver directly.
6. Ongoing Reviews: Care plans are often subject to periodic reviews to ensure that the care provided aligns with the recipient's needs.

Family caregivers and care recipients need to communicate with their state Medicaid office or a knowledgeable counselor to understand their state's specific requirements and procedures. This will help ensure that caregivers are appropriately compensated for their services.

Learn more about Medicaid consumer-directed care >>

Limitations and challenges

The Medicaid waiver programs, including the Personal Choices Program, have certain limitations and challenges that need to be acknowledged. Some of these include:

1. Funding Constraints: Medicaid is a jointly funded program by the state and federal governments. However, the resources are limited, and the funding levels may only sometimes be sufficient to meet the demands of all eligible participants.
2. Waiting Lists: Many states have waiting lists for Medicaid waiver programs due to funding limitations. This means that even if an individual is qualified, they may have to wait an extended period before receiving services.
3. Gaps in Coverage: Not all services are covered by Medicaid waiver programs, and sometimes there are gaps in the type or duration of services that can be accessed, which can be particularly challenging for individuals with complex or chronic healthcare needs.
4. Complexity and Bureaucracy: The application and management processes for Medicaid waivers can be complicated and bureaucratic, creating barriers for individuals trying to access services, especially those with limited literacy or language barriers.
5. Geographic Limitations: In some cases, services may not be readily available in certain geographic areas, particularly in rural regions.

A note from Givers

Recognizing and supporting caregivers is paramount for the well-being of caregivers and those they care for. Fill out this survey to determineif you are eligible for compensation. Take advantage of this opportunity to get the support you deserve.