Benefits Flashcards

Which federal program is the primary payer for Medicaid-funded Personal Care Assistant services in most US states?

Answer: Medicaid HCBS Waiver

Medicaid Home and Community-Based Services (HCBS) waivers fund PCA services for eligible individuals who would otherwise require institutional care.

Medicare covers home health aide services only when a patient also requires which of the following?

Answer: Skilled nursing or therapy services

Medicare home health benefits require a skilled care need (nursing or therapy); aide services are covered as supplemental to skilled care, not standalone.

A PCA client receiving Supplemental Security Income (SSI) must keep countable assets below what federal limit for an individual?

Answer: $2,000

SSI recipients may hold no more than $2,000 in countable assets ($3,000 for couples) to maintain eligibility.

Under the Veterans Affairs program, eligible veterans can receive PCA services through which benefit?

Answer: Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The PCAFC provides stipends, healthcare, and caregiver support for veterans who need PCA-level assistance due to service-connected conditions.

Self-directed PCA programs differ from agency-based PCA services primarily because they allow the client to:

Answer: Hire, train, and manage their own PCA

Self-directed programs give clients employer authority, letting them recruit, hire, and direct their own PCA within program guidelines.

Which Medicaid benefit structure uses an annual budget allocation that clients can manage themselves to purchase approved services including PCA care?

Answer: Individual Directed Goods and Services budget

Individualized budgets within self-directed Medicaid programs let participants allocate a set dollar amount across approved personal care and support services.

When a PCA client transitions from a nursing facility back to home, which Medicaid benefit is specifically designed to support that move?

Answer: Money Follows the Person (MFP) demonstration

Money Follows the Person is a federal-state initiative that helps individuals move from institutions to home and community settings with enhanced Medicaid support.

Under the Family and Medical Leave Act (FMLA), an eligible PCA employee may take up to how many weeks of unpaid, job-protected leave per year?

Answer: 12 weeks

FMLA entitles eligible employees at covered employers to up to 12 weeks of unpaid job-protected leave for qualifying family or medical reasons.

If a PCA is injured while lifting a client at work, which benefit program would cover medical treatment and lost wages?

Answer: Workers' compensation

Workers' compensation is a state-mandated insurance program that covers employees for work-related injuries, including medical costs and wage replacement.

The Fair Labor Standards Act (FLSA) requires that home care workers employed by third-party agencies be paid overtime at what rate for hours over 40 per week?

Answer: 1.5x regular rate

The 2015 FLSA rule extended overtime protections to most home care workers, requiring time-and-a-half (1.5x) for hours exceeding 40 in a workweek.

Which tax is withheld from a PCA employee's paycheck to fund both Social Security and Medicare programs?

Answer: FICA tax

FICA (Federal Insurance Contributions Act) taxes fund Social Security and Medicare; employees and employers each pay a share.

A newly hired PCA who is classified as an independent contractor instead of an employee would NOT receive which of the following benefits?

Answer: Employer-paid FICA contributions

Independent contractors pay the full self-employment tax (both employee and employer portions of FICA), losing the employer's matching 7.65% contribution.

An employer-sponsored health insurance plan that allows employees to contribute pre-tax dollars to pay for qualified medical expenses is called a:

Answer: Flexible Spending Account (FSA)

A Flexible Spending Account (FSA) lets employees set aside pre-tax income for eligible healthcare expenses, reducing their taxable income.

Under the Affordable Care Act, employers with 50 or more full-time equivalent employees must offer health coverage or face a penalty under which provision?

Answer: Employer Shared Responsibility provision

The ACA's Employer Shared Responsibility provision (also called the employer mandate) requires large employers to offer affordable coverage or pay a fee.

Respite care is a benefit primarily designed to provide which of the following?

Answer: Temporary relief for unpaid family caregivers

Respite care gives informal caregivers short-term breaks by providing temporary substitute care, reducing caregiver burnout.

Long-term care insurance benefits typically activate after a policyholder needs assistance with how many Activities of Daily Living (ADLs)?

Answer: 2 ADLs

Most long-term care insurance policies require the insured to need help with at least 2 of 6 standard ADLs before benefits are payable.

A client enrolled in a hospice benefit under Medicare must agree to which of the following conditions?

Answer: Forego curative treatment for the terminal illness

Electing hospice under Medicare means the patient focuses on comfort care and waives the right to curative treatment for the terminal diagnosis.

Personal Emergency Response Systems (PERS), such as medical alert buttons, are often covered as a Medicaid waiver benefit because they help clients:

Answer: Remain safely at home and avoid institutionalization

PERS devices are covered under many HCBS waivers because they support independent living at home and can prevent costly emergency hospitalizations.

A PCA's role in helping a client access community benefits includes assisting with applications for services. Which document most commonly establishes a client's functional eligibility for PCA Medicaid benefits?

Answer: Level of Care assessment or functional assessment

A Level of Care or functional needs assessment evaluates the client's ADL limitations and determines whether they meet the threshold for PCA Medicaid services.

Which of the following best describes the benefit of a managed long-term services and supports (MLTSS) plan versus traditional fee-for-service Medicaid for PCA clients?

Answer: Coordinated care with a single plan managing all benefits

MLTSS integrates acute and long-term services under one managed care organization, improving care coordination for clients with complex needs.