ADvantage Program 101

The ADvantage Program is a Medicaid waiver program that provides home and community-based services in lieu of nursing home care for those who qualify. The goal is to help at-risk seniors stay safely in their homes.

The ADvantage Program

In Oklahoma, the ADvantage Medicaid waiver program offers funding for a variety of in-home and community-based services for people age 65 or older with chronic illnesses and for adults age 21 or older with physical disabilities. To qualify, you must meet Medicaid waiver health and financial requirements.

Currently, the monthly income limit is $2,382 per individual with no more than $2,000 in assets (not including the value of your home and car). You also must meet nursing home level-of-care guidelines to qualify for the program. Nursing home level of care means that without the services the waiver provides, you would be at risk of nursing home placement. Oklahoma’s Department of Human Services (OKDHS) determines if you meet the criteria and are eligible for the program.

Although the ADvantage program doesn’t provide 24-hour care, for many people simply having help with daily tasks may be all they need to stay at home.

All services provided by the ADvantage program are based on the individual’s needs. Along with case management, services may include:

Personal care assistance with daily activities such as bathing, housekeeping, meals and shopping Home-delivered meals

Durable medical equipment such as grab bars, shower chairs, hand-held showerheads and extended toilet seats Incontinence products Prescription drugs

Home modifications, including installation of ramps or widening doorways Adult day health services

ADvantage assisted living facilities (limited availability in the Tulsa area) Nursing services

Physical, occupational, speech and respiratory therapies Respite care Hospice care

How the Program Works

To apply for Oklahoma’s ADvantage program, call your local OKDHS office or the toll-free ADvantage line at (800) 435-4711. You can also call LIFE’s SeniorLine at (918) 664-9000, ext. 1184 for help applying for ADvantage.

You will be sent a packet of forms requesting your financial information that must be returned within 10 days. An OKDHS nurse will then schedule a home visit to assess the level of care you need. OKDHS has up to 45 days to determine if you meet the financial and level-of-care criteria.

Once you are approved for the ADvantage program, the first thing you will do is choose an ADvantagecertified agency as your case management provider. You will also choose an ADvantage-certified agency for any nursing or personal care services you may receive. If you don’t have a preference, an agency will be assigned to you. If you choose, you can hire and supervise your own worker to provide your personal care services.

Your case manager will meet with you in your home. A team approach, comprised of your case manager, a nurse, other service providers and any friends or family you wish to include, is used to develop your personal care plan. Your team will meet with you to discuss your goals and create a plan of services. Your case manager arranges and coordinates your services and must contact you at least monthly to ensure services remain in place as long as needed. Your plan can be changed as your needs change. You can stay on the ADvantage program as long as your needs can be safely met at home and you continue to meet the program’s level-of-care and financial requirements.