What is the difference between a nursing home and a personal care home? Nursing homes are licensed medical facilities that are inspected and licensed by the Pennsylvania Department of Health. They must meet both state and federal regulations. There is third-party reimbursement (Medicare and Medicaid) for those who qualify based on income. Personal care homes are residential facilities that offer personal care services, assistance, and supervision to four or more persons. They are inspected and licensed by the Pennsylvania Department of Human Services. A personal care home must have a license to operate in Pennsylvania. There are state licensing regulations that apply to personal care homes. These regulations are aimed at protecting the health, safety, and well-being of the residents. There are no federal regulations for personal care homes. There is no thirdparty reimbursement for personal care homes, but many accept residents of low income who receive Supplemental Security Income (SSI). — Pennsylvania Department of Human Services Is there someplace I can get help with drug bills for someone in my care? Many senior citizens with low incomes are eligible for assistance with payment for their prescribed medications through PACE/PACENET programs. Who is eligible for PACE? For a single person, your total income must be $14,500 or less. For a married couple, your combined total income must be $17,700 or less. Social Security Medicare Part B premiums are now excluded from income. Prescriptions: Co-pay for generic drugs is $6; co-pay for single-source brand is $9. Who is eligible for PACENET? To be eligible for PACENET, the qualifications are the same as PACE. However, the total income for a single person can be between $14,500 and $27,500. A couple’s combined total income can be between $17,700 and $35,500. Prescription: Co-pay for generics is $8; co-pay for single-source brand is $15. Call your local Area Agency on Aging www.BusinessWomanPA.com
office for forms or more information or go to https://pacecares.magellanhealth.com. Effective Jan. 1, 2019, PACENET cardholders not enrolled in a Part D plan will pay a $37.03 premium at the pharmacy each month. Income qualification is based on prior year’s income and includes taxable and nontaxable sources. Assets and resources are not counted as income. — Pennsylvania Department of Aging What is the Extra Help Program? If your monthly income is up to $1,581 for singles ($2,134 for couples) and your assets are below specified limits, you may be eligible for Extra Help, a federal program that helps you pay for some or most of the costs of Medicare prescription drug coverage. You can enroll through the Social Security Administration, using either the agency’s print or online application, or at your local Medicaid office. If you are enrolled in Medicaid, Supplemental Security Income, or a Medicare Savings Program, you automatically qualify for Extra Help. You do not have to apply for this extra assistance. If you become eligible, you will get a special enrollment period to enroll in a Medicare private drug plan. See www. medicare.gov for more information. What is the APPRISE Program and where can I get more information? The APPRISE Program is a free program operated by the Area Agencies on Aging to provide healthinsurance counseling and assistance to Pennsylvanians age 60 and over. They can help you understand Medicare benefits by explaining Medicare, Medicare Supplemental insurance, Medicaid, and long-term care insurance. They can explain the Medicare appeals process, help you select a Medigap insurance policy, explain the Medicare prescription Part D benefit, and explain financial assistance programs. Call 800.633.4227 or your local Area Agency on Aging for more information. What is the waiver program offered through the Pennsylvania Department of Aging? There are several waivers available through the Pennsylvania Department of Aging for people aged 60 and older who
meet the eligibility requirements and income limits. Each waiver has its own unique set of eligibility requirements and services. • Aging Waiver – Provides long-term care services to qualified older Pennsylvanians living in their homes and communities • Attendant Care / Act 150 – Information for mentally alert Pennsylvanians with physical disabilities • COMMCARE Waiver – Home and community-based program developed for individuals who experience a medically determinable diagnosis of traumatic brain injury • Consolidated Waiver for Individuals with Intellectual Disabilities – Provides services to eligible persons with intellectual disabilities so they can remain in the community • Independence Waiver – Provides services to persons with physical disabilities to allow them to live in the community and remain as independent as possible • LIFE (Living Independence for the Elderly) – Managed care program for frail, elderly recipients who have been determined to need “nursing facility level of care” but wish to remain in their home and community as long as possible (called PACE in other states) • OBRA Waiver – Provides services to persons with severe developmental physical disabilities, such as cerebral palsy, epilepsy, or similar conditions • Family Directed Support Waiver – Provides services to eligible persons with intellectual disabilities so they can remain in the community What services are available from Pennsylvania Area Agencies on Aging? Area Agencies on Aging, county- or multi-county-based agencies that partner with the Department of Aging, provide a wide range of services, such as assessment of need, care management, in-home services, transportation, protective services, adult daycare, and legal services. Services may vary from county to county, so it is wise to call your local Area Agency on Aging for particular services of programs.
caregiver solutions 2019 BUSINESSWoman
17