Ask Mike - How do I pay a personal assistant for taking care of me when I am disabled?

Dear Questioning,

You write to ask a basic, but very important question. If I understand the question correctly, you want to know where the money comes from to pay for the services.

There are four basic sources of funding for personal assistance services:

1. Out-of-pocket, also called "private pay" - Some people spend their own money for the personal assistance they need. They hire their own personal assistants either from an agency such as a home health or visiting nursing agency. In this case, the assistants are already trained, licensed and supervised by the agency. In other instances, people pay family members, friends or strangers that are trained and supervised by the disabled individual or family member that has hired them.
2. State/local funding - It is unusual, but some states, cities, or counties fund some personal assistance. These programs are usually fairly limited in type and scope of assistance provided and do not meet comprehensive needs such as those of an institutional level. These programs can be more flexible and creative and less bureaucratic than Medicaid and Medicare.
3. Medicaid - Medicaid is the largest payer of personal assistance. For comprehensive personal assistance, this is probably your best bet. Medicaid is a state/federal partnership that is uniquely designed and administered by each state. The federal government matches at least 50% and up to 83% of what the state appropriates according to federal guidelines. There are two basic types of Medicaid funded PAS: Waivers and Personal Care Option. To qualify for a Waiver, nursing facility or institutional levels of need, both financial and functional, must be met. This means that a person must typically be very poor and fairly significantly disabled in order to qualify for assistance.
4. Medicare - This is 100% federally funded and basically is a health insurance program for retirees due to age or disability. There is limited personal assistance for people who are homebound and need certain types of nursing or home health services.

The PAS Center website can be of assistance with finding out more about what is available in your state and community. Go to our Agencies Related to PAS web page and select your state. On the next page that comes up, click on "Medicaid Agency" and also click on "State Independent Living Council and Centers for Independent Living". These pages will give you the contact information for resources that can answer your questions and also help you with finding out about sources of funding for personal assistance.

If you really want to dig in to learning more, you can try using the PAS Center's internal search capability. On the top left corner of each page you will find "Search This Site". Try typing the main funding streams from my answer one at a time - Medicaid, Medicare, private pay, personal care option and Waiver. Believe me, a whole bunch of different information will come up that you can browse through and/or decide to read about more in depth.

Thank you very much for sending in your question.

Mike Oxford