Frequently Asked Questions About the LIFE Program

Below are answers to frequently asked questions about Pennsylvania’s Living Independence for the Elderly (LIFE) program. Visit www.palifeprograms.org to find a program that serves your zip code.

What does LIFE stand for?

LIFE stands for Living Independence for the Elderly.  In other states, the program is called PACE or the Program for All-inclusive Care for the Elderly.

Why haven’t I heard about this before? Is LIFE a new program?

LIFE advocates always say it’s the best kept secret in senior care! It has been an option for Pennsylvania seniors for almost 30 years and more than 8,000 seniors are currently part of the program. LIFE is a managed care program, meaning the provider receives a fixed amount of money from Medicare and Medicaid to cover all of the care the participant needs – whether it costs more or less. The commonwealth has another managed care program called Community HealthChoices or CHC, but LIFE was established long before CHC and it is still an option for everyone who qualifies.

How can LIFE programs be a health plan and a provider at the same time?  

The LIFE program is a joint Medicare and Medicaid program that was created to help seniors coordinate all of their coverage and care through one team of professionals who are experts in working with older people. LIFE programs have an agreement with the federal government and another agreement with Pennsylvania to receive a monthly fee that covers all of a participant’s Medicare and Medicaid needs. Since the LIFE program is also the provider of services, that means your care team can address whatever you need without the hassle of figuring out insurance coverage for every specific service.

What services does LIFE offer?

Based on regular reviews of your care plan and requests for services that you or your family make, the LIFE care team determines the services each participant receives, which can include:

  • Medical services, including specialists like podiatrists
  • Eye and dental care
  • Prescription drugs
  • In-home services like assistance with bathing, dressing, light housekeeping
  • Meals at the LIFE day center or delivered to home
  • Home mobility equipment like grab bars and ramps
  • Home medical equipment like incontinence supplies or testing strips
  • Visits to the LIFE day center for medical care, meals, and socialization
  • Transportation to medical appointments and the LIFE day center

Who provides LIFE program services?

The LIFE program provides some services with its own employees and others through a network of providers in your community. Your LIFE program will have an in-house physician but they might also work with your own primary care doctor. Either way, the program arranges for all the services determined necessary by your team of health care professionals to improve and maintain your overall health. This team includes specially trained doctors, nurses, social workers, therapists, nutritionists, and other health care professionals who meet at least monthly to talk about your care plan and make sure you have everything you need. LIFE provides care and services in the home, the community, and the LIFE day center.

How do I know if I’m eligible for LIFE?

You’re eligible for LIFE if you:

  • are 55 years old or older
  • have been determined by the state to need at least the level of care provided by a nursing facility
  • have been determined financially eligible for Medicaid (or you pay monthly LIFE premiums on your own)
  • have been determined by the LIFE program to be able to live independently in the community if you get the help you need from LIFE

You also need to live in a part of Pennsylvania that is currently served by a LIFE program. You can search by zip code under “Locate a LIFE Program” at www.palifeprograms.org.

I don’t know if I meet the medical or financial criteria. How do I find out?

Interested LIFE applicants need to complete some of the same processes that all individuals do before accessing Medicaid long-term care services in the community. You have to show that your income is below the limit to receive help from Medicaid and that your personal care needs are at least at the same level as someone in a nursing home. Your local LIFE program can help you navigate the eligibility process. Go to the “Locate a LIFE Program” on www.palifeprograms.org to find the program that serves your zip code and reach out for free help with the application process.

Your medical eligibility is determined by an independent assessor employed by your local Area Agency on Aging. That assessor will visit your home to ask you questions about the help you need with day-to-day activities. Your financial eligibility is determined by a local county caseworker using an application that you can submit online or walk through with a LIFE program employee.

I think I already have Medicaid coverage from Community HealthChoices, can I switch to LIFE?

Yes. Your local LIFE provider can help you make the switch. As long as you also meet the LIFE eligibility requirements, you can switch from Community HealthChoices into the LIFE program.

What if I join and I don’t like it. Do I need to wait for a specific time of year to switch out of the LIFE program?

If LIFE isn’t right for you, you can disenroll at any time. It’s a voluntary program. If you have Medicare, you will need to choose a Medicare plan to continue covering your care as well as a prescription drug plan if applicable. If you have Medicaid, you will need to choose a Community HealthChoices plan to take over your coverage. Your disenrollment can usually be effective by the first day of the month following your request.

What’s a LIFE day center? Is that like a senior center?

A LIFE day center is similar to a senior center but it is much more. LIFE day centers are staffed by LIFE doctors and nurses and other health care professionals. They’re a positive, welcoming place where you and other LIFE participants socialize while receiving services from the clinical team. Senior centers generally may not provide clinical care and older adult daily living centers (also called adult day centers) provide personal care and medication assistance, but they do not have a doctor’s office or therapy room and they do not offer services outside of the center.

What can I do at the LIFE day center?

At your LIFE day center you can:

  • see your LIFE doctor or nurse
  • receive physical, occupational, speech, or cognitive therapy
  • receive social work counseling, including grief counseling
  • meet with a dietician
  • participate in educational programs
  • participate in recreational and cultural activities
  • eat a meal or snack
  • participate in fitness programs
  • receive help showering or doing laundry
  • socialize with friends old and new

With so many people in your corner and so many services at your fingertips, you are more likely to remain happy, healthy, and independent in the care of a LIFE program.

Am I required to go to the LIFE day center?

Since most of your LIFE doctors and caregivers are there, you’ll need to go to the day center to see them when you have appointments but no, you’re not required to go there for anything else. Your LIFE care team will work with you to figure if and how often you want to visit the center for socialization and meals.

I see a lot of doctors and others who help me with my care. Does LIFE cover all of that?

Yes, your medical care is covered when you see a LIFE provider or someone inside their provider network. LIFE’s clinical experts help you determine the medical services you need and then they arrange for those services to be delivered. LIFE day centers even provide doctor visits right down the hall while you’re there for a yoga class or a video game tournament.  

Can you be more specific about the kinds of providers who would be helping me if I join a LIFE program?

Federal rules require all LIFE programs to employ an 11-member interdisciplinary care team to review and plan for your care on a regular basis. This will include the following types of professionals; all focused on your needs:

  • primary care practitioner (doctor, PA, NP)
  • registered nurse
  • social worker
  • physical therapist
  • occupational therapist
  • recreational therapist (activities director)
  • dietitian
  • LIFE day center manager
  • home care coordinator
  • personal care attendant
  • transportation van driver

With their eyes on your care, the LIFE team can recognize changes and new needs as they come, setting up and paying for anything else you need to stay at home.

This sounds like I’d be making a lot of trips to doctors but I don’t get around as well as I used to. How am I going to do all that?

Many of these services, including primary care and nursing services, are available at the LIFE day center, which you would be able to visit regularly – and the round trip to the LIFE day center is free. When services aren’t available at the center, LIFE provides free transportation to medical appointments. In addition, services can be provided in your home when necessary. Whether it’s in the center, at an in-network doctor’s office, or at home, LIFE even makes all of these appointments for you.

Someone told me I’ll have to give up my doctor if I sign up for LIFE. Is that true?

There’s no rule that says you can’t keep seeing your own doctor. LIFE programs have their own doctors who specialize in caring for older adults and hold appointments right at the day center for you. LIFE participants usually find it easier to switch to the LIFE doctor for that reason. But if your doctor is okay with joining the LIFE provider network, the program can pay for those visits and you can keep that relationship.

If I join LIFE, do I give up control over my medical decisions and the care I receive?

Not at all. You work closely with your LIFE care team every step of the way. You and your family can also make service requests to the care team and they’ll review your circumstances to decide if you need something new.

What if I have a special medical need or I’m in the middle of treatment for something when I join LIFE. Do I have to give up my specialist?

While LIFE programs have their own doctors and a network of physicians that they normally work with, in certain circumstances you can finish a course of treatment with an out-of-network doctor for conditions you had before you enrolled in LIFE.

Some self-care tasks are starting to get tough for me, like getting in the shower. Will LIFE help me with that?

Yes. Your LIFE program is your partner in keeping you as independent as possible for as long as possible. For all of us, everyday tasks get challenging as we get older. For example, some seniors can no longer drive, so they need help getting to the doctor; others may have trouble getting into and out of the bathtub; others can no longer do the laundry on their own because the basement stairs are too challenging. We get it – and we’re here to help.  

Your LIFE care team will visit your home, assess your needs, arrange for any assistance you need, and help you live more safely and comfortably. When it’s approved by your care team, it comes at no cost to you!

I’m having trouble living by myself. Can LIFE help me with that?

Absolutely. To help you remain in your home and in your community for as long as you can, LIFE offers a variety of in-home services. Based on an assessment from your LIFE care team, your in-home services can include:

  • personal care aides to help you with things like bathing, grooming, and dressing
  • help doing laundry, at home or in the LIFE day center
  • light housekeeping assistance
  • help getting to the grocery store
  • in-home modifications like grab bars in bathtubs
  • in-home medical equipment like walkers and incontinence supplies
  • personal emergency notification and response systems (an alert button)
  • transportation or an escort for your medical appointment

Can LIFE help me get around town for things like appointments, pharmacy pick up, or grocery shopping?

Absolutely. LIFE provides free transportation to and from the LIFE day center for appointments with center staff as well as rides to doctors’ offices in the community. The program can also provide someone to go with you if you need that kind of support. LIFE delivers your medicine free of charge, but they can surely help you with transportation to the pharmacy and grocery store too.

How much does it cost to join LIFE?

The LIFE program coordinates seniors’ medical care, personal care, and prescription benefits so how much you pay depends on the coverage you have for those services. If you have Medicaid coverage or Medicare and Medicaid, you won’t pay a monthly premium for LIFE enrollment. If you don’t have Medicaid but you do have Medicare, you’ll be charged a monthly premium to cover the personal care portion (like personal assistance at home) and a premium for Medicare Part D drugs. If you join a LIFE program, you’ll get your Part D-covered drugs and all other necessary medication from the LIFE program. You don’t need to join a separate Medicare Prescription Drug Plan.

How much are the co-pays?

There’s no deductible to meet and no co-pay for any drug, service, or care approved by your health care team. If you seek care that is not authorized by your LIFE care team or from a provider outside of the network, you could be responsible for that cost. Participants who spend more than 30 days in a nursing facility may be responsible for some of those costs, depending on their income and family situation.

What about my prescriptions and the medical supplies I need?

If you are eligible for Medicare and Medicaid, you generally pay nothing for prescriptions (including home delivery), medical equipment, or supplies.

Some of the medicine I use isn’t a prescription. I just buy it in the drug store. Does LIFE help with that?

In many cases, yes it does. As directed by your LIFE care team, LIFE helps with many over-the-counter drugs that are part of your care plan. It depends on your own situation, but this could include things like diabetes testing supplies, bandages, and incontinence supplies.

My pharmacy bills are getting expensive. Does LIFE help with that?

Yes. You can receive your prescriptions at the LIFE day center or have them delivered to your home, without charge, and they come specially packaged for easy access and with clear instructions. LIFE even offers reminders of when and how to take your medicine, if you want that extra support.

If you do not have Medicaid, you’ll pay the LIFE program monthly for Medicare Part D premiums so they can get your prescriptions from Medicare with no co-pays.

 

Do I have to give up my home or have a lien placed on it if I participate in LIFE?

The LIFE program is focused on helping you continue living in your home for as long as it is safe. Like all Medicaid long-term services, including nursing home and home health care, there are Pennsylvania rules on estate recovery that apply to LIFE participants. In some cases, that estate recovery includes a lien on your primary residence. You should speak to an attorney specializing in estate planning to plan for your long-term care needs, including protecting assets for your family. 

How does LIFE help support families caring for their loved ones?

LIFE programs recognize that in many cases, some of your care comes from family members and other caregivers and we want to support them too. LIFE offers caregiving training, support groups, and respite care to help families keep their loved ones in the community. Your care team will stay in communication with any family members that you wish to be part of your care.