Virginia’s Medicaid Waiver Programs
Virginia’s Commonwealth Coordinated Care Plus Waiver, a combination of the waivers formerly known as the Elderly and Disabled with Consumer Direction Waiver and the Technology Assisted Waiver Waiver, helps seniors and disabled individuals receive long-term care services in the community.
The CCC Plus Waiver program provides care in the home and community, rather than in a nursing or other specialized care facility, to those who require a hospital or nursing home level of care. To eligible individuals who are 65 or older or disabled, and certain others who are functionally dependent and have medical nursing needs, the CCC Plus Waiver program offers services like adult day health care, respite care, personal care, medication monitoring, private-duty nursing, environmental modification, assistive technology, emergency response systems, and case management for those who live at home. Depending on your income, you may have to pay a portion of the cost of your services under this program. In this program, you can choose to either have an agency hire and supervise your personal care attendants, or you can choose to hire and supervise your own. If you choose the “consumer-directed” model, the state will assign a services facilitator to help you coordinate your own care.
Other waiver Programs are available for Virginians with intellectual or developmental disabilities. For more information about those, contact your local Community Services Board.
Medicaid Coverage Of Home Health Services
If you receive Medicaid, the program will pay for some limited home health care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you.
If you need ongoing home services to help you do activities of daily living or manage your medications, Medicaid will not cover that type of help. Instead, you should consider whether you qualify for any of Virginia’s several Medicaid Home and Community Based Care Waiver programs or its Program for the All-Inclusive Care of the Elderly that provide home and community-based care services to low-income residents. To qualify for most of Virginia’s waiver programs for home care, you must meet the nursing home level of care, as discussed in Nolo’s article on when Virginia’s Medicaid program pays for nursing homes.
Services My Way Program
The Services My Way Program is designed for Medicaid eligible, Pennsylvania residents who are elderly and/or disabled. Services are provided on the Cash and Counseling model, also referred to as consumer-direction or participant direction, which means individuals can choose their own care providers as opposed to the state agency making such decisions on their behalf. This method is not necessarily a waiver, but its a way that waiver participants can obtain home care services.
SMW Program participants work with a Case Manager from the state to help determine a plan for a level of care and a budget for goods and services. This is known as a participants Individual Service Plan. Participants can then choose people such as neighbors, friends, and some family members to serve as caregivers. An Employer Agent from the SMW Program is responsible for making payments to the care providers to offer care, which participants approve.
To qualify for Medicaid paying for homecare, individuals must be Pennsylvania residents that qualify for either the PA Community HealthChoices Program or the Attendant Care Program through Medicaid. Individuals must require nursing home level care, and financial requirements are dependent on age and marital status. Additionally, there are requirements related to income and asset limits.
- Adult Day Services
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What Home Care Services Are Covered In Choices
Here are some of the kinds of home care covered in CHOICES. Some of these services have limits. Your MCO will help you to determine what services below will meet your needs.
Some of these services can be provided through Consumer Direction.
Consumer Direction is a way of getting some of the home care you need that offers more choice and control over WHO gives your home care and HOW your care is given than receiving CHOICES services and not consumer directing. You actually employ the people who provide some of your home care services they work for you . This means you must be able to do the things that an employer would do like hire, train, and schedule workers.
You can hire a family member, friend, neighbor, or other person you know to provide care in Consumer Direction, but there are some limitations. We want to support, but not replace, care already provided by family and friends. Youll find out more if you sign up for CHOICES.
LTSS Help Desk: 1-877-224-0219
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When Is Adult Daycare Right For Your Loved One
If you can provide for most of your loved ones needs but want a helping hand to watch over them while you work, or when you need a break from providing them with help and support, adult daycare can be a great option. Another key benefit of adult daycare is that it can help with the isolation that many older individuals may experience after retirement, as it gives them a chance to socialize with others in a safe, supportive, and friendly environment.
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Medicaid Adult Day Care Eligibility
Every Medicaid program in every state has its own eligibility considerations. Generally speaking, most adult day care is provided under Medicaid waivers. Eligibility for waivers considers the applicants income and financial resources, as well as their functional ability. In most states, waivers require the participant to be in need of nursing home level care.
In 2022, most waivers limit the participants monthly income to less than $2,523. Excluding the value of their home, their countable assets are limited to $2,000 for the majority of states Applicants with resources or income in excess may be able to qualify for Medicaid by working with a Medicaid planning professional.
Eligibility for Medicaid-funded, adult day care under a Medicaid state plan is both less and more restrictive than with a waiver. Applicants do not necessarily need to require nursing home level care. This is good news for persons with Alzheimers or dementia who require supervision, but not 24 / 7 care.
Financially, the asset limit is the same as with Medicaid waivers, but the monthly income limit is likely more restrictive. Typically, it is pegged to the Supplemental Security Income benefit rate , or 100% of the Federal Poverty Level . Again, as with waivers, there is some flexibility when calculating what qualifies as monthly income.
How Much Do Home Care Services Cost
The second step in deciding if in-home care is the right fit for an aging loved one is to estimate costs. In-home care costs vary by location as well as by service level. Home health care that is provided by trained medical professionals like registered nurses and therapists is the most expensive level of care at home. According to Genworth’s most recent Cost of Care Survey, the national median cost of home health care is $27 per hour. The median hourly cost of non-medical home care, such as homemaker services and custodial care, is $26.
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Iii Medicare Coverage Of In
When it comes to Medicare coverage of in-home care, it is crucial to distinguish between standard home care and home health care. Medicare does not cover any standard in-home care because it is considered custodial care rather than health care. However, Medicare does cover eligible home health care services, which we explore in more detail below. Furthermore, in some cases, Medicare may actually cover custodial in-home care if delivered with home health care services from the same provider. Ultimately, seniors and their families should be aware that theyre unlikely to get help from Medicare paying for regular in-home care, but may have at least some home health care services covered by Medicare.
Long Term Care Insurance
In some circumstances, long term care insurance policies can be used to pay spouses for caregiving, but much is dependent on the specific policys rules. For example, the policy must cover non-medical, personal care provided at home. If a policy pays out cash benefits directly to the policyholder, there would be no need to pay a spouse, since the spouse is already sharing in the benefits. However, if the policys rules state that they will only pay out to licensed care providers, then a couple might want to pursue this option. There are multiple steps involved in this process. The caregiving spouse may need to become a licensed non-medical, home care provider and register with their state. Their newly formed home care agency is hired by the care recipient. Once care is provided, they invoice for their hours, and those invoices are sent to the long term care insurance company for payment. Though initially logistically challenging, this option can bring significant income to a caregiving spouse over the long term. Long term care policyholders whod like assistance establishing this arrangement should contact us to be connected with an expert.
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Home And Community Based Service Waivers
In addition to state Medicaid plans, there are additional programs or waivers to provide services such as:
- Assisted living
- Protective supervision
Programs can offer a combination of standard medical services and non-medical support.
These programs also aim to help prevent nursing home placement. Unlike IHSS, Medicaid waivers are not entitlement-based programs, meaning that there are enrollment caps on services and once these are reached, there is a waitlist.
The Multipurpose Senior Services Program
This waiver provides supportive services such as assistive technology, protective supervision, respite, transportation, meal services and home modification. Find out more about the MSSP Waiver.
The Home and Community-Based Alternatives Waiver
Previously the Nursing Facility / Acute Hospital Waiver, this is a combination of several former waivers and enables individuals to receive care services at home, including medical care. Find out more about the HCBA Waiver.
Community Based Adult Services Program
This CBAS program provides daytime care, meals, social activities, therapies, and skilled nursing. Functional needs must be met. Find out more about the CBAS program.
At Luxe homecare, were focused on ensuring you and your loved ones receive the best care available. If youre eligible through Medi-Cal for our services, find out how we can help with our tailored in-home support. Get your important questions answered right away. Contact Luxe online or call 459-3535 to get started.
How To Get Medicaid Coverage For Care At Home
Traditionally, Medicaid has paid for long-term care in a nursing home, but because most individuals would rather be cared for at home and home care is cheaper, all 50 states now have Medicaid programs that offer at least some home care. In some states, even family members can get paid for providing care at home.
Medicaid is a joint federal-state program that provides health insurance coverage to low-income children, seniors, and people with disabilities. In addition, it covers care in a nursing home for those who qualify. Medicaid home care services are typically provided through home- and community-based services waiver programs to individuals who need a high level of care, but who would like to remain at home.
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City, State
Medicaids home care programs are state-run, and each state has different rules about how to qualify. Because Medicaid is available only to low-income individuals, each state sets its own asset and income limits. For example, in 2021, in New York an applicant must have income that is lower than $884 a month and fewer than $15,900 in assets to qualify. But Minnesotas income limit is $2,382 and its asset limit is $3,000, while Connecticuts income limit is also $2,250 but its asset limit is just $1,600.
States also vary widely in what services they provide. Some services that Medicaid may pay for include the following:
- In-home health care
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Social Managed Care Plan
A Social Managed Care Plan provides the full range of Medicare benefits by standard Managed Care Plans. These are membership plans and offer other health benefits not provided through Medicare alone or most other senior health plans.
The services the organization offers home and community based services:
- Care coordination
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How Can I Find Medicare
Your doctor most likely works with Medicare-certified home health agencies regularly, so he or she may be able to make a recommendation. Alternatively, you can search Medicare’s website for certified agencies near you, along with their quality and patient survey ratings. Ask plenty of questions to ensure the agency provides the type of care you need and that you feel comfortable with those who will care for you.
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How Much Does Adult Day Care Cost In 2021
As of May 2021, the average daily rate for adult day care facilities in the U.S. is $74, according to Genworths 2020 Cost of Care analysis. The services provided, the city or state where the facility is located, and the individuals needs can all impact the cost of adult day care. There are generally two types of adult day care
When Might Medicare Cover In
In general, Medicare doesnt cover long-term home health care. Heres how Medicare coverage of in-home health care typically works.
In most cases, even when Medicare covers in-home health care, its for part-time care, and for a limited time. Some of the requirements may include:
- You must be under the care of a doctor, who must have a plan of care for you that she or he regularly reviews.
- The in-home health agency must be Medicare-approved.
- Your doctor must certify that youre unable to leave your home without some difficulty for example, you might need transportation and/or help from a cane, a walker, a wheelchair, and/or someone to help you. In other words, youre homebound.
- Your doctor has to certify that you need certain kinds of in-home care, such as:
- Skilled nursing services when you dont need constant care. That is, you need these services intermittently.
- Continued occupational therapy*
- Speech language pathology*
This may not be a complete list.
*Medicare has certain rules about covering this type of service. If your doctor orders it for you, you may want to contact your Medicare Advantage plan, or Medicare, to see if itll be covered. Contact information for Medicare is at the bottom of this page.
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Examples Of What The Home Health Staff Should Do:
- Check what youre eating and drinking.
- Check your blood pressure, temperature, heart rate, and breathing.
- Check that youre taking your prescription and other drugs and any treatments correctly.
- Ask if youre having pain.
- Check your safety in the home.
- Teach you about your care so you can take care of yourself.
- Coordinate your care. This means they must communicate regularly with you, your doctor, and anyone else who gives you care.
Using Life Insurance To Pay For Home Care
There are a few ways that seniors who have life insurance policies can use them to pay for home care. Options include taking a loan from the policys cash value or surrendering the policy entirely in exchange for the cash value.
Some policies may feature an accelerated death benefit rider, which is a cash advance that is subtracted from the death benefit amount the beneficiary receives upon the death of the policy holder. The owner of the policy must be terminally ill with a limited life expectancy or be deemed unable to perform basic activities of daily living . The policy is not surrendered at the time of the cash advance, so the policy holder must continue to pay the premiums to guarantee the beneficiary receives what remains of the original death benefit. The insurance company will require physicians statements and medical records attesting to the illness or loss of function before they will pay out any early benefits.
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What Should I Expect From My Home Health Care
- Doctors orders are needed to start care. Once your doctor refers you for home health services, the home health agency will schedule an appointment and come to your home to talk to you about your needs and ask you some questions about your health.
- The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.
- Its important that home health staff see you as often as the doctor ordered.
Does Medicare Cover Assisted Living Facilities For Dementia Patients
Assisted living facilities are a popular choice. Most assisted living facilities charge rent and a fee based on the assistance a resident needs.
Original Medicare doesnt cover assisted living rent nor does it cover fees for personal care. Yet, Original Medicare will cover healthcare you get in assisted living.
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Medicaid Coverage Of In
Medicaid is a joint state and federal program that provides health coverage to seniors with low income and limited assets. Benefits are administered on a state level, so eligibility requirements and covered services can differ greatly.
Depending on where a senior lives, the fundamental Medicaid State Plan may cover both home health care and personal care services. Some states have expanded their Medicaid coverage through the use of waivers to provide services for populations that might not be eligible otherwise. Home & Community Based Service Waivers can be used to pay for in-home health care and non-medical home care services. In many states, family caregivers can get paid for the care they provide through Medicaid Cash and Counseling programs.
Check your states Medicaid website for information on specific eligibility guidelines, waiver programs, services that are covered and how to apply.
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