Aging in Place in Your State: Rhode Island and Pennsylvania

In some states, it’s difficult to find, much less quality for, government programs that will help pay for home modifications, assistive technology, and other adaptations to help people age in place.

And in others, like this week’s featured states, there are an abundance of programs, ranging from the standard Medicaid waivers to alternative state programs and even, in one case, a foundation offering low- to no-interest loans and grants.

This illustrates the reality that benefits available to help people stay in their homes and communities vary widely from state to state. They also change fairly often; for example, Pennsylvania is just finishing a two-year roll-out of a new Medicaid waiver “umbrella” program, and residents are experiencing both the excitement and the frustration that change can bring.

But there’s something available in every state, and wherever Evolve can bring families, contractors, and benefits programs together, we will. This month, we’re highlighting home modification help available in Rhode Island and Pennsylvania. We’ll continue this monthly post until benefits for all 50 states are explained — and post periodic updates as those programs change.

Rhode Island

Rhode Islanders who need help with aging in place are in a unique situation. All of the state’s previous Medicaid waivers were merged in 2009 into the Rhode Island Global Consumer Choice Compact.

This waiver, also known as the Rhode Island Comprehensive Demonstration, established “a new federal-state compact that provides the state with greater flexibility to provide services in a more cost effective way that will better meet the needs of Rhode Islanders,” according to Rhode Island’s Executive Office of Health and Human Services.

What that means to Rhode Island’s residents is that they can access a wide variety of benefits under the umbrella of this single program — and the program allows “self-direction,” where recipients of benefits choose their own caregivers, even family members. Covered services under the “global” waiver include various types of personal, nursing and “homemaking” care, and delivery of meals and other types of respite care. It also covers home modifications like ramps, grab bars, and the like; and vehicle modifications like lifts and driver aids.

To qualify, elderly Rhode Island residents must have a monthly income not exceeding about $2,300 per month, or 300% of the Federal Benefit Rate. Liquid assets — bank accounts, cash, etc. — must not exceed $4,000, though a primary home valued at less than $585,000 is not counted. People whose incomes exceed the program’s limits may still quality for reduced benefits in which they use excess income to help pay medical expenses. According to payingforseniorcare.com, this component of the program functions in much the same way as an insurance deductible: “once one has ‘spent down’ their income to the allowable amount, they will be eligible for Medicaid for the remainder of the ‘spend down’ period.” Residents must also be careful that, in attempting to reduce their assets to qualify for benefits, they do not run afoul of Medicaid look-back rules, which govern asset reduction.

In addition to the global waiver, Rhode Island offers home modification benefits through its Home and Community Care Co-Pay program. According to the Rhode Island Department of Human Services, this non-Medicaid benefit system “pays a portion of the cost of personal care and adult day services. An individual must be unable to leave home without considerable assistance and must need help with personal care.”

For more information on Rhode Island’s global Medicaid waiver and co-pay programs, visit the state’s Human Services department at http://www.dhs.ri.gov.

Pennsylvania

Pennsylvania recently completed a two-year process of rolling out a new statewide managed-care waiver program, Community HealthChoices. Every eligible resident of the state has been automatically enrolled in CHC, with representatives reaching out to help people enroll in one of three managed care organizations approved by the state to operate under the CHC umbrella.

Numerous medical and behavioral services, as well as long-term care, are offered as part of CHC, including home modifications like ramps, stairlifts, grab bars, and the like; as well vehicle modifications.

Qualifying Pennsylvanians must have an income no greater than $2,313 per month (300% of the Federal Benefit Rate). They may retain up to $8,000 in personal assets, not including a home worth up to $585,000, household furnishings, personal possessions, and purchased burial plots. Married applicants can distribute a portion of their income to a non-applying spouse, up to $3,160 per month. Non-applicant spouses may also retain more of the couple’s joint assets, up to $126,420.

News coverage reports some delays in receiving benefits as the new program finishes its rollout. For more information, visit the Pennsylvania Department of Human Services at www.dhs.pa.gov.

Pennsylvania also offers PA Options, a non-Medicaid assistance program designed to help people stay in their homes as long as possible through various support services. PA Options can be utilized after all other funding possibilities are explored, and it is funded primarily through block grants, meaning that there may be waiting lists for services.

Applicants receive a needs assessment and eligibility interview by a case manager, who helps them navigate the various service offerings. Case managers may approve home adaptations “made to improve consumer safety, increase functionality, improve accessibility, and to assist in the provision of care to a consumer in his/her home,” according to the Pennsylvania Department of Aging. A home’s basic footprint may not be changed in approved work, and multiple bids must be solicited. There is a lifetime cap of $15,000 on benefits received under the PA Options program.

Another option for Pennsylvania residents needing home modifications is to apply for a loan from the Pennsylvania Assistive Technology Foundation. Any state resident of any income level who is able to repay the loans’ very generous terms is eligible to apply. Zero-interest and low-interest loans are available, as well as grants. Since 2002, the foundation has provided $40 million in loans to almost 4,000 people.

The PATF defines assistive technology as “any device that helps a person with a disability achieve a more independent and productive life.” According to the foundation’s web site, loans may be used for such items as adapted vehicles; computers; iPads and other tablets; smart home technology; home modifications like ramps, roll-in showers and lowered countertops; and safety and security devices.

To find out more about Community HealthChoices, visit http://www.healthchoices.pa.gov/info/about/community/. For more information about PA Options, visit the state Department of Aging at www.aging.pa.gov. For information about PATF, visit https://patf.us.