Waiver Description
This Oklahoma Medicaid waiver is designed to help seniors remain living in their homes or the home of a family member instead of in a nursing home environment. Seniors participating in the ADvantage Program can access a variety of long-term care services, such as personal care and assistance, home modifications for increased safety and access, and adult day care.
Participants in this program have the option of letting the state manage the care services they receive or self-directing their own care. Self-direction — also referred to as participant direction — is through the associated program option Consumer-Directed Personal Assistance Services & Supports (CD-PASS).
Under the CD-PASS program option, participants are free to choose their own personal care providers. Family members are eligible to be hired and paid to provide personal care services for the participant. While exceptions exist, in some conditions, spouses and legal guardians can be paid to provide care.
Another option available under ADvantage is assisted living. Formally called the Assisted Living Service Option (ALSO), ALSO is available to all program participants.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
Eligibility Guidelines
General Requirements
To be eligible for this Medicaid waiver, an applicant must be a resident of Oklahoma. Age, functional ability, income, and assets are also all qualifying criteria for the ADvantage Program.
Age and functional ability are related. Persons 21 years of age and over are eligible if the Social Security Administration designates them as disabled. Persons 65 and over do not require full disability; instead, they must have a need for the level of care provided in a nursing home.
Financial Requirements
Financially, the ADvantage Waiver requires that applicants qualify for Oklahoma’s Institutional Medicaid, also referred to as SoonerCare.
Income Limits
In 2024, the SoonerCare income limit for long term care services for a single applicant is $2,829 per month.
If the applicant is married and his or her spouse is not also applying for Medicaid, there are spousal impoverishment standards in place. This is intended to prevent the non-Medicaid spouse from having too little income on which to properly live. As of 2024, the applicant spouse is able to transfer up to $3,853.50 per month of his or her income to the non-Medicaid/non-applicant spouse. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted.
Asset Limits
The countable resources (asset) limit is $2,000. However, certain assets are considered exempt. For instance, an applicant’s primary home, given he or she lives in it, and the equity value is under $713,000, is exempt.
In addition, when only one spouse of a married couple is applying, the non-applicant spouse can keep 50% of the couple’s assets, up to $154,140 (as of 2024). If the couple’s assets are under $30,828, the non applicant spouse can keep all of the assets, up to this amount.
Over the Financial Limits?
Couples interested in preserving as much of their retirement savings as possible should consult a Medicaid planning adviser. These experts can usually help to restructure assets and income so that couples can maximize the spousal allowances and ensure eligibility. Read more.
WarningIt is vital that applicants do not give away cash and other non-exempt assets in an effort to meet the asset limit. Gifting countable assets, or selling them for less than they are worth, within 60-months of filing a Medicaid application violates Medicaid’s look-back period. This can cause a period of Medicaid ineligibility, defeating the purpose of trying to meet the asset limit.
Benefits and Services
The ADvantage Waiver is intended to help the elderly remain living at home. Waiver participants can be approved to receive any of the following services. Certain unskilled services, most relevantly personal care, are available for self-direction.
- Adult Day Health Care / Adult Day Care
- Assisted Living Services – Assistance with laundry, preparing meals, housecleaning, mobility, hygiene, etc.
- Case Management
- Consumer Directed Personal Assistance Services / Supports
- Disposable Medical Supplies
- Home Modifications for Improved Access – Ramps, lifts, roll-in showers, widening of doorways, etc.
- Home Delivered Meals
- Hospice Care
- Occupational Therapy
- Personal Care – Aid in activities of daily living, such as bathing and dressing
- Physical Therapy
- Prescription Drugs
- Specialized Medical Equipment
- Speech Therapy
- Respite Care
- Nursing / Skilled Nursing
- Personal Emergency Response System (PERS)
- Restorative and Supportive Assistance – For individuals with a chronic condition that is stable, such as a need for an external catheter
- Transition Services from Institution
- Transportation – Medical and Non-Medical
How to Apply / Learn More
The ADvantage Waiver is a SoonerCare program managed by the Aging Services Division of the Oklahoma Department of Human Services. More information on the program is available here.
One can apply online or call the Medicaid Services Unit at 800-435-4711 for assistance with applying.
While available throughout Oklahoma, waiting lists may exist.
