Cost Sharing

Cost Sharing with HBFAAA

Cost Sharing – Income-Based Payment For In-Home Care

Huntingdon-Bedford-Fulton Area Agency on Aging

Older adults who need in-home care services and are ineligible for financial assistance through Medicaid or one of Pennsylvania’s state Medical Assistance Waiver programs are responsible to pay a monthly co-payment toward the cost of care services. The Huntingdon-Bedford-Fulton Area Agency on Aging is required by the Pennsylvania Department of aging to document each consumer’s income to calculate the consumer’s portion of the cost of the services provided. The purpose of this monthly co-payment is to help ensure the continuation of services for older Pennsylvania residents.

A Needs & Income Assessment will be completed. After the Assessment is completed, the consumer will be notified in writing regarding the consumer’s monthly share of the cost for services. The amount is billable and due on a monthly basis.

Which Services Are Subject to Cost Sharing?

Which Services Are Subject to Cost Sharing?

We are not required to charge a fee for some services.
Regardless of your income, you will not receive a bill for:

  • Home Delivered Meals
  • Assessments
  • Protective Services
  • Care Management, pending cost sharing regulations are met
  • APPRISE Medicare Counseling Services
  • General Services (Walk-In & Informational Services)

We are required to complete a financial assessment for the following services.
If your income is above certain limits, you may receive a bill for:

  • Personal Care Services
  • Home Support Services
  • Some Specialized Services

What Sources of Income Are Counted For Cost Sharing?

What Sources of Income Are Counted For Cost Sharing?

Consumers who filed a Federal Income Tax Return for the previous year will receive a Cost Sharing calculation based on adjusted gross income. This amount will include non-taxable income such as Social Security Benefits. All others will be asked to show proof of the following types of income. You are required to provide copies.

  • Alimony
  • Black Lung Benefits
  • Child Support
  • Dividends & Interest
  • Estate & Trust funds
  • Government Retirement Pensions
  • Net Self-Employment Income
  • Private Pensions, Annuities &Union Benefits
  • Public Assistance & SSI
  • Railroad Disability
  • Railroad Retirement
  • Rental Income
  • Social Security Benefits
  • Unemployment Compensation
  • Veterans Pensions
  • Wages, Salaries, & Tips
  • Workers Compensation

Some types of income are not considered when calculating your monthly Cost Sharing payment:

  • Food Stamps
  • Income Tax Refunds
  • Low Income Home Energy Assistance
  • Medicare, Medicaid, FCSP, & PACE
  • Property Tax & Rent Rebates

You are required to show proof of income to receive services; however, consumers who choose not to disclose income may have a Cost Share rate of 100% of the actual cost of services.

Billing: You will receive a monthly bill by mail for your co-payment for In-Home Care Services subject to Cost Sharing. The bill is due monthly upon receipt.

Inability to Pay: Services are provided to consumers on a shared responsibility basis between the Huntingdon-Bedford-Fulton Area Agency on Aging and the consumer. Unfortunately, the Huntingdon-Bedford-Fulton Area Agency on Aging will be forced to terminate payments if payments from the consumer are not received in according to the payment schedule. If you are having financial difficulties due to a change in your financial situation, contact your County Office. Adjustments to income can be made at any time.

Ongoing Income Verification: Income is verified each year. If you experience a significant increase or decrease in income, you are encouraged to contact us right away.

Service Limitations: Financial caps on In-Home Services are established each year. More information regarding the amount of the yearly service cap can be obtained from your care manager. In some circumstances, limited exceptions to this cap may be authorized for special needs.

What Does Nursing Home Appropriate Mean?

What Does “Nursing Home Appropriate” Mean?

Individuals who are at least 60 years of age and who are determined to meet the qualifications for a nursing home level of care, but who prefer to continue receiving In-Home care services may be able to access more options to help stay independent at home as long as possible. As long as the cost of In-Home care services does not exceed the cost of nursing home care, the consumer may be considered for the PDA Waiver. Under the PDA waiver programs, consumers are able to access professional home healthcare services provided by therapists, registered nurses, etc. in the home environment.