Goals and Objectives:
The Department of Social Services operates the Personal Care Assistance Waiver Program to assist eligible disabled adults by providing services that complement the 1915(k) state plan option established in July 2015. This Medicaid Waiver Program gives adults with permanent, severe, and chronic physical disabilities access to both waiver and state plan services for self-care activities, enabling them to live in the community rather than an institution. The PCA Waiver offers a flexible, cost-effective alternative to institutionalization that isn't based on the medical model, designed to give consumers control over their lives and greater independence in a community setting.
Organizational Structure:
The Department of Social Services (DSS) directly administers the PCA Waiver. DSS ensures that all individuals receiving waiver services meet the categorically and medically needy eligibility and income/asset requirements. DSS calculates each consumer's share of liability for waiver services costs. DSS also informs eligible individuals of their due process rights and offers them a choice between institutional or home and community-based services.
The Department's Community Options Unit administers the waiver, accepts applications, performs initial level of care determinations, and refers clients to contracted case management providers for initial evaluation, care level confirmation, and service plan development. DSS determines both financial and functional eligibility. Case management providers conduct annual face-to-face evaluations.
DSS contracts with a fiscal agent to credential providers. Self-directed PCA is available under the state plan 1915(k) option. The Department receives quarterly reports to oversee the waiver program. Additionally, DSS maintains program oversight through routine quality assurance activities, including staff meetings, training, case conferences, consumer record maintenance, and staff supervision.