Frequently Asked Questions

How can I find out about caregiving resources in my community?

There are resources with staff who can help you figure out whether and what kinds of assistance you and your care receiver may need.

The local Area Agency on Aging is one of the first resources you should contact when help is needed caring for an older person. Almost every state has one or more AAAs, which serve local communities, older residents, and their families.

In a few states, the State Unit or Office on Aging serves as the AAA. You can find your Area Agency on Aging in the Directory of Ancillary Services on page 30.

If your care receiver lives in another community and you aren’t sure what county that is, you can also call the National Eldercare Locator, a toll-free service funded by the Administration for Community Living, at 800.677.1116.

The Eldercare Locator can help you find their local or state AAA. Eldercare Locator operators are available Monday through Friday, 9 a.m. to 8 p.m., Eastern Time. When contacting the Locator, callers should have the address, zip code, and county of residence for the person needing assistance. The Eldercare Locator is also available online athttps://eldercare.acl.gov.

If your family member has a limited income, he or she may be eligible for AAA services, including homemaker home health aide services, transportation, homedelivered meals, and chore and home repair, as well as legal assistance. These government-funded services are often targeted to those most in need.

While there are no income criteria for many services, sometimes you may have more service options if you can pay for private help.

AAAs can direct you to other sources of help for older persons with limited incomes, such as subsidized housing, food stamps, Supplemental Security Income, and Medicaid.

Supportive services for the person needing care can include both in-home and community-based services, such as: • Transportation • Meals • Personal and in-home care services • Home healthcare • Cleaning and yardwork services • Home modification • Senior centers • Respite services including adult daycare

If you are an employee covered under the federal Family and Medical Leave Act, and if you meet the eligibility requirements, you are entitled to take up to 12 weeks of unpaid leave during any one year to care for certain relatives.

Will Medicaid help pay for home healthcare?

Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. To qualify for Medicaid, you must have a low income and few savings or other assets.

Medicaid coverage differs from state to state. In all states, Medicaid pays for basic home healthcare and medical equipment. Medicaid may pay for homemaker, personal care, and other services that are not paid for by Medicare.

For more information about what Medicaid covers for home healthcare in your state, call your state medical assistance office. If you need the telephone number for your state, call 800.633.4227

What is the difference between a nursing home and a personal care home?

Nursing homesare 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 homesare 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 isno thirdparty reimbursementfor personal care homes, but many accept residents of low income who receive Supplemental Security Income (SSI).

Assisted living residences generally offer the same amenities as personal care homes.

However, because of the higher level of care provided in an assisted living residence than in a personal care home, if a resident’s health declines and nursing care is required, the resident does not have to move and is able to “age in place.”

Assisted living residences are required to offer living units with kitchenettes and private bathrooms.

— 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?

• You must be 65 years of age or older.

• You must be a Pennsylvania resident for at least 90 days prior to the date of application.

• You cannot be enrolled in the

Department of Human Services’

Medicaid prescription benefit.

For a single person, total income must be $14,500 or less. For a married couple, combined income must be $17,700 or less.

Who is eligible for PACENET?

• You must be 65 years of age or older.

• You must be a Pennsylvania resident for at least 90 days prior to the date of application.

• You cannot be enrolled in the

Department of Human Services’

Medicaid prescription benefit.

PACENET income limits are slightly higher than those for PACE. For a single person, total income can be between $14,500 and $27,500. For a married couple, combined total income can be between $17,700 and $35,500.

Prescriptions: Co-pay for generic drugs is $8; co-pay for single-source brand is $15.

Call your local Area Agency on Aging office for forms, or more information or go to https://pacecares.magellanhealth.com.

Effective Jan. 1, 2020, PACENET cardholders not enrolled in a Part D plan will pay a $35.63 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. 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.

Program counselors 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 800.633.4227or 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, countyor multi-county-based agencies that partner with the Department of Aging, provide a wide range of services, such as assessment of need, care management, inhome 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 or programs.

What is the Medicare Savings Program (MSP)?

The Medicare Savings Program helps pay for Medicare premiums. In some cases, the Medicare Savings Program may also pay Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance, and copayments if a beneficiary meets certain conditions.

What are Medicare Preventive Services?

Early detection and treatment of health conditions can help reduce medical costs and maintain health. Many preventive care services are covered at a low or no cost. Talk to your doctor about preventive services available to you through Medicare.