My mother has been approved for Medicaid Long Term Care. We would like to hire a private personal care aide instead of going through a home health agency. My question is "What is the process of using her Medicaid to pay for a private personal care aide such as a family member"? Any information you can provide me will be greatly appreciated.
Thanks in advance.
Ann
You mentioned that your mother is eligible for "Medicaid Long Term Care." Is your mother going to be a resident in a facility, or is your mother still living at home, in the community?
If she is living in the community, your state's Medicaid program will have reimbursement plans to pay caregivers, but you have to fit the services into the framework of your state's program.
My state (Massachusetts) offers Adult Foster Care (AFC) for people who cannot live alone safely, and who have a family member or trusted friend who wants to devote time and attention that provides 24-hour care. AFC pays the caregiver an annual tax free stipend. The program is sometimes called by the names of agencies that serve as the overseers of the host caregiver: Adult Family Care and Caregiver Homes.
Another program in my state, Personal Care Attendant (PCA), allows you to hire a son, daughter or any family member (but not a spouse). The program pays for home care services for people who need daily assistance with ADLs. But the elder must submit time slips to a "fiscal intermediary" which processes payroll checks and income tax withholding.
Community Choices is a program that provides as much support/services as needed for people who are clinically frail enough to qualify for immediate nursing home admission.
Senior Care Options (SCO) combines Medicare and Medicaid.
To get specific answers to questions about Medicaid payment for care in your state, talk with your local Aging Services Access Point or an Elder Law Attorney.
If your loved one is not in a nursing home she is participating in what is known as a "Medicaid Waiver Program". In Virginia, the program she is most likely participating in is called "Commonwealth Coordinated Care Plus".
Under this program, as it is in more and more states, Virginia contracts with managed care companies to coordinate and pay for long-term care services delivered in a venue outside of a nursing home (at home or in an assisted living facility.
The managed care companies then contract with private providers, such as home care agencies, to deliver services to the Medicaid recipient.
By clicking the following link you will find that there are 6 such entities in your county.
https://www.cccplusva.com/choose/compare-plans?location=27
In the case of home care, these entities contract with private companies to deliver care to the Medicaid recipient and they, in turn, pay the home care companies.
Importantly, with your respect your question, most states require that these plans offer a "Patient Directed Option" where the Medicaid recipient can hire virtually anyone they choose, including a family member, who then gets paid by the managed care plan.
Unfortunately, in my experience, the reimbursement rate under Patient Directed Options is very low; like $7-$10 dollars per hour. which is generally wholly inadequate.
Another option which I suggest to my clients is to consider having the caregiver they prefer get hired by one of the aforementioned contracted home care agencies.
Now comes the really technical part in terms of meeting your goal:
There is a difference between a "home care agency" and "home care registry".
When a care provider works for a home care agency they are a direct employee of the agency. The agency pays for all related bonding and insurances and withholds taxes, etc. The employee may not have freedom of choice with respect to assignments, hours worked, etc.
A home care registry, however, differs in that the care provider simply "registers" with the company which acts as a middle man of sorts. The care provider is typically responsible for paying their own insurances, taxes, etc. and is generally free to work with more than one registry at a time. Essentially, they are an independent contractor.
The caveat under both scenarios is that the care provider will have to be certified as a Home Health Aide or Certified Nursing Assistant. These certifications, however are relatively simple to obtain.
By having the care provider work through a nurse registry that is contracted with a Medicaid managed care plan, my clients have been able to get the maximum benefits available from a care giver they prefer.
I hope this helps in achieving your care giving goal.
Thanks.
Ann
Read the information provided in this link.
I think this question has been asked before on the forum. One respose was the facility may not allow you to bring an aide from the outside.
My mom was in a care home for a couple of years. The facility required that my mom have a 24/7 attendant off and on through the two years. That had to be paid out of pocket. There are always situations where this is necessary. How facilities handle it could very well be different. Some facilities probably require a specific agency be used, but still paid for out of pocket.
Hospices do not require Medicaid and has nursing homes, but if you put your parent in there they will let them die without food and water, and give them plenty of narcotics to help the process.
FYI: In Florida the Medicaid Home and Community Based Services waiver program will provide personal home care services in the home as well as a stipend towards the cost of care in an assisted living facility. Adult Day Care would also fall under this program. There is a wait list for this waiver program.
Nursing home benefits do not fall under Home and Community Based Services and are available to a qualified Medicaid recipient at any time.
Here is some information. Caregiver Homes of Mass
State pays for 24hour care. Usually a family member or relative.
There are eligibility requirements to qualify for AFC.
$9,000- $18,790 payment determines one's level of care.
I do not know what state your mother lives in but there are programs like this throughout the US. Call the number and maybe they can direct you further. Hope this helps.
Some states have invested heavily in helping people age at home, some are still testing programs (run out of money during the year) and some simply aren't there yet. They each have the ability to manage Medicaid funding the way they choose to a large degree (staying within certain parameters), they also may contribute state funds to some of these programs so how they choose to allocate these funds can be vary greatly and it all depends on how much value (and probably work) they want to put on quality of life for their senior population among other things. It's a nightmare but it can also be a blessing if your in the right state I guess! This is over simplified of course if Federal requirements dictated that to get Medicaid funds or more Medicaid funds a state had to provide a stay home program that would come into play too and there are all kinds of Federal strings attached to these funds....
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