Office of Aging
Cost Sharing for Aging Services
As part of the statewide effort to expand in-home services to the elderly, local area agencies on aging are instituting cost sharing. Cost sharing is part of the larger home and community based care expansion made possible by the Tobacco Settlement funding. The following are some basic questions and answers about cost sharing. For more specific information, please contact Centre County Office of Aging at (814) 355-6716 or aging@co.centre.pa.us
Frequently Asked Questions
Q: I thought the Lottery paid for services for senior citizens. Why are seniors being asked to pay for in-home services?
A: While the Pennsylvania Lottery provides for many services to seniors, the demands placed on the fund continue to be greater than the money available. Currently about 5000 older Pennsylvanians are waiting for in-home services due to insufficient Lottery funds.
Q: What does the Tobacco Settlement Plan have to do with cost sharing?
A: Part of the Tobacco Settlement distribution makes more money available to provide services to the 8000 people on waiting lists for in home services. This is a one time allocation of $10 million. Centre County's share is $61,101. Funds received from cost sharing will provide money for services in the coming years.
Q: How can older people be expected to afford the high cost of home health services?
A: The new statewide cost sharing plan provides for a minimum living allowance of $895 per month before anyone is expected to pay anything toward service costs. For married couples, the minimum living allowance is $1210 per month.
Q: How will the Office of Aging know how much money I have?
A: Our care managers visit at home and discuss income information with older people privately as part of the service assessment . The care managers will need to see copies of tax returns, 1099 forms or other proofs of income. This information will only be used to determine whether a person must pay for any part of his or her service. It is considered confidential information and is treated that way by our office staff.
Q: How will I know how much I have to pay?
A: After the assessment, our office staff will calculate the cost of your care plan and determine what you will have to pay. You will be given a copy of your cost share and you can then decide if you want to receive the services based on your cost share. Then, each month, you will be billed for the portion of your care based on services you actually received.
Q: What if I don't agree to pay for services?
A: You will be notified about the cost of your care and what your share of that cost will be. You may choose to refuse care, to discontinue care or to pay your share.
Non-payment for care will result in loss of Office of Aging paid service. For instance if your share is 50%, and you do not pay for care, the Office of Aging will discontinue paying for the remaining 50%. You will be responsible for the total cost of care if you choose to continue services. There will not be any penalty charges, but if care is to begin again, outstanding balances must be paid.
Q: What will the agency do with the money that I pay for my care?
A: The agency will use the money to provide care to other needy older adults. An audit will be conducted each year to assure that funds are not used for any other purpose.
Q: What if I think my bill is not correct?
A: If you think that you are being billed for services that you did not receive or that the bill is incorrect, you should contact our office immediately. The name and contact person are printed on the bill.
Q: Will my cost be different from my neighbor's cost?
A: Cost share is based on a number of factors: consumer's income, cost of service provider, amount of service received, and allowable medical deductions. It is not likely that anyone will have the same exact charge as any other person. People can pay as little as 2% of the cost or as much as 100% of the cost. Cost share increases with each 5% increase in income.
Q: How much of a medical deduction is allowed when figuring cost share?
A: Medical costs above 7.5% of gross income are allowed as a deduction.
Q: Can you give me an example of how cost share is calculated?
A: Suppose your monthly income, including Social Security, pension, and some interest is $1500 for one person. You are receiving 3 hours of personal care each week at a rate of $16.49 per hour (4.3 weeks per month). You also pay for health insurance and prescription drugs at a cost of $150 per month ($450 allowable deduction). Your adjusted monthly income is $1462.50. The cost of your care plan is $212.72 per month. Your share is $94.66, a 44.5% cost share.
Q: What should I do if I have more questions?
A: Contact the Office of Aging at (814) 355-6716 and ask to speak to your caseworker or to the fiscal officer.
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