Medicaid Funded Home Care Services


Federal Help As Part Of Covid Recovery

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The federal government, recognizing the importance of home care in light of the COVID-19 pandemic, is also beefing up cash to the sector through the American Rescue Plan Act.

The temporary 10% bump in the federal share of Medicaid funding for home and community-based health care means that Ohio will get a total of $460 million between April of this year and March of 2022.

The state has until March 2024 to use that additional money to make changes to the home-health system. While one-time, immediate needs from the coronavirus will be considered, the goal is to pinpoint more sustainable, long-term investments, Ohio Department of Medicaid Director Maureen Corcoran told lawmakers.

Providers in home care are eyeing the federal money and have already submitted feedback to the department on how to use that funding.

While most are looking at using money from increased reimbursement rates to help agencies make ends meet, they want to dedicate much of the federal aid to improve wages and work conditions for direct care workers, said Jordan Ballinger, policy director for Disability Rights Ohio, part of the Ohio HCBS Coalition.

“They’re making $12 an hour and Ohio’s estimated $13 an hour is what meets basic needs,” he said. “I think we should go above and beyond basic needs for these direct care workers.”

Workforce development is also another big priority, with issues exacerbated by the pandemic. Videk said since the beginning of 2020, around half of visiting nurses have left.

There’s A Shortage Of Home Health Aides For The Elderly And It’s Getting Worse

“More and more people are saying, if I need care, I’d like it to be done at home or here in my community versus an institution or a hospital or a nursing home,” says Health Secretary Xavier Becerra. “In the 21st century, we’re moving closer to a care model that’s based on giving people services in their home.”

Becerra adds that his own father spent his last few months in hospice at home. “When he passed, he was in my home, he was surrounded by family,” he says.

Medicaid recently surpassed 80 million beneficiaries the most ever since the program was created in the 1960s. It is the primary provider of long-term care services for older people, since these are not covered by Medicare or private insurance.

The move towards home- and community-based care has been gradual since Medicaid started, says , an associate director at the Kaiser Family Foundation’s program on Medicaid and the uninsured. “This is really the first new funding that we’re seeing for home and community based services really since the Affordable Care Act in 2010,” she says.

“Back in 1965, the world was very different, societal expectations were different,” she explains. “For example, if you had a child born with a significant disability, it was much more likely that you might institutionalize that child from a very young age. Medical science and technology had also not advanced to the point where it is now.”

Long Term Care Options

  • Personal Care : Home Attendant and Housekeeping services for individuals having difficulty with at least one or more activities of daily life. Individuals must be Medicaid eligible and otherwise exempt from Managed Long-Term Care or Managed Care. In addition to Personal Care services, there is also a Consumer Directed Personal Assistance Program.
  • Managed Long-Term Care Program: Covers case management, nursing, home health aides, home attendant services, physical therapists for people who are Medicaid eligible, or eligible for both Medicaid and Medicare, and are medically eligible for long term care services. More information from the NYS Department of Health.
  • Assisted Living Program: Long term residential care, find more information on this state administered program.
  • Long Term Home Health Care Program: Plan of medical, nursing and rehabilitative care provided at home to persons medically eligible for placement in a nursing home. These individuals must have care costs which are less than the nursing home cost in the local county. Individuals can access this program through a hospital discharge planner, HCSP, or a Long Term Home Health Care Provider.

HRA’s Office of Special Services oversees the Home Care Services Program. For assistance, please call Infoline at 718-557-1399 or visit your local Home Care CASA Office.For more information on Customized Assistance Services, please visit

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Investing In Dental Care To Save Money In The Long Run

According to CareLink CEO Gadbois, In 2019, the CareLink team made 14,083 visits and served more than 3,000 patients at 53 nursing homes throughout the state. However, at any given time there are 8,000 people in our states nursing homes, and our population is aging. Demand is outpacing our ability to serve everyone who needs mobile dental care right now, because were a nonprofit that has to address a $135.69 gap between our costs and the amount that the state reimburses us for every Medicaid patient we see.

Related issue in New Hampshire:Expensive dental care leads to bad teeth, poor health and pain for many

Said Dr. Jeffrey Dodge, lead dentist with CareLinks Mobile Dentistry Program: Were reducing stress, gum disease and pain and improving the general quality of life of our patients while saving taxpayers money by avoiding the long-term cost of poor overall health. Investing in this program will save the state money in future health-care costs.

What Is Private Duty Home Care

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Seniors, people living with disabilities and those who need help while recovering from an illness or injury often turn to private duty home care services for assistance. This type of care is provided through an agency, or directly from a private caregiver.

Private duty home care is home care that is delivered on a private-pay basis, which means clients or their families pay either the home care agency or the caregiver. Because the service works on an individual basis, private duty home care services can be customized to meet the unique needs of each client.

Clients who hire a private duty home care provider have the ability to access as much support as they feel they need, without seeking approval from their primary care physician or any other medical professional. With private duty care, there are no eligibility requirements, and clients are free to use the service on a short-term or long-term basis.

Another important distinction of private duty home care is that home care agencies have the flexibility to match caregivers with clients based on skills, preferences and overall compatibility. This flexibility leads to a high level of client satisfaction, and that can help increase profits for the home care agency.

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‘long Overdue’ Effort To Boost Reimbursement Rates

State Sen. Louis P. DiPalma, chairman of the Senate oversight committee and first vice chair of the Senate finance committee, seeks to change that.

DiPalma is spearheading an effort to increase reimbursement rates, which are set by the state Executive Office of Health and Human Services and not just for dental care but for a wide array of other health-care services that government finances as well. He is collaborating with Rep. Julie A. Casimiro, first vice chairwoman of the House Oversight Committee, on this larger initiative to establish a process for rate reimbursement review and setting.

“Hundreds of thousands of folks are impacted by these rates,” said DiPalma, who will introduce legislation in the 2022 session of the General Assembly. DiPalma is also working with the Executive Office of Health and Human Services in the hope of securing additional funding when Gov. Dan McKee submits his proposed budget for the next fiscal year.

Alleged neglect at Eleanor Slater Hospital

Incremental attempts to raise one rate or another will not work, DiPalma said.

There’s a forest of trees in front of us, he said. What we’re doing now is trying to whack one tree at a time, figure out how to address that one thing. And we need to do this at a macro level and do it in a regular basis. This is long overdue and must be accomplished posthaste.

Tell The Case Manager About Your Needs

Your case manager will tell you what services your Home and Community Care Support Services organization can provide and whats available in your community. Government-funded services are delivered by health professionals and personal support workers who are under contract with your Home and Community Care Support Services organization.

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Monitoring And Consultation On Psychotropic Medications

Children and youth involved with child protection are prescribed psychotropic drugs at a higher rate than Medicaid-enrolled children in general and are at higher risk for polypharmacy. Medicaid is the primary payer for these psychotropic medications and, in many states, child protection and Medicaid leaders are collaborating to determine best practices, ensure effective monitoring, and implement relevant practice protocols. For example, Massachusetts has implemented consultation to primary care practitioners on the appropriate use of psychotropic medications. In addition, data from the Medicaid pharmacy system are analyzed for children involved with child protection to identify outliers, including both children and prescribers, so that a system to address these cases can be implemented. This is an example of how Medicaid claims data can be beneficial. Medicaid can partner with child protection agencies to ensure children receive psychotropic medications appropriately.

Developing qualified providers

  • A specialty provider initiative in Arizona sought to develop expertise to ensure that the Medicaid behavioral health provider network includes providers with specific skills. The state developed practice protocols that outline procedures for coordinated service planning and delivery to guide behavioral health service delivery to children in child welfare.
  • Tennessee developed a Specialty Provider Network for the child welfare population within its Medicaid managed care system.

Who Is Eligible For A Health Home

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Health Homes are for people with Medicaid who:

  • Have two or more chronic conditions
  • Have one chronic condition and are at risk for a second
  • Have one serious and persistent mental health condition

Chronic conditions listed in the statute include mental health, substance abuse, asthma, diabetes, heart disease, and being overweight. Additional chronic conditions, such as HIV/AIDS, may be considered by CMS for approval.

  • States can target health home services geographically
  • States cannot exclude people with both Medicaid and Medicare from health home services

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Check If You Qualify For Government

Your case manager will determine if you qualify.

If you dont qualify, you may be able to receive services through community agencies, which may require a co-payment.

You can arrange and pay for services through a private company. Your local Home and Community Care Support Services organization can help you find services in your community.

Leveraging The Family First Prevention Services Act

What distinguishes states with more effective Medicaid delivery systems is their long-standing collaborative approaches between child protection, Medicaid, and behavioral health systems that respect the pressures facing each system while also developing common goals and understanding of the unique needs of this population. Often, federal opportunities create further incentive for child protection and Medicaid systems to work together to improve the quality and lower the cost of physical and behavioral health care for children in child welfare. A recent mandate in child protection, the Family First Prevention Services Act, provides an opportunity for these systems to develop an evidence-based service array to both prevent the entry of children into foster care and placement disruption among children who are in adoptive or relative guardian homes. The act calls on states to develop an array of effective mental health, substance use, and parenting programs, some of which can be funded through Medicaid and others through child welfare Title IV-E.

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Who Provides The Services And How Do I Access Them

For Medicaid-eligible persons, local social services districts usually contract with home-care agencies that employ aides to provide Medicaid funded personal care services, and New York State oversees the local social services districts administration of the program.

For a person to receive services, his or her doctor must send a completed Physician´s Order to the local social services district, which then arranges a social and nursing assessment of the individual. A nurse assessor uses the results of the assessments, together with the physicians order, to recommend an appropriate amount, frequency and duration of services.

The local social services office then notifies the individual of the services that will be provided. The need for services is reassessed approximately every six months.

Click here if you think you have an immediate need for Personal Care Services and would like more information on how to get your eligibility processed more quickly for these services.

Does Medicare And Medicaid Cover Home Care

The Application &  Enrollment Process for Home Medicaid ...

Medicare and Medicaid are government-funded health insurance programs for seniors age 65 and older, and eligible adults with qualifying disabilities. Medicare Part A and Medicare Part B cover some home health services such as intermittent skilled nursing care, occupational and physical therapy, medical social work, speech-language therapy and limited personal care.

Medicare and Medicaid only provide limited coverage for home health care services under specific circumstances, and services are delivered through agencies that are under contract with the government. Service availability varies in each state and is subject to change each year.

Many states promote the use of Medicaid and Medicare-funded home care services as a way to delay or reduce institutionalization rates among medically-fragile seniors and people with disabilities. According to Genworths 2019 Cost of Care Survey, the national median cost for nursing home care in a private room is $8,517, while home health aide and homemaker services cost $4,385 and $4,290 respectively. Note that costs vary throughout the country, and care costs tend to be linked to the local cost of living.

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Fact Sheet #79f: Paid Family Or Household Members In Certain Medicaid

This fact sheet provides general information regarding how the FLSAs requirements apply to the employment of a family or household member paid through certain Medicaid-funded and certain other publicly funded programs offering home care services.

Who are paid family or household care providers?

Certain Medicaid-funded and certain other publicly funded programs allow a recipient of home care services to select and supervise the care provider and further allow the selection of a family or household member of that person as a paid care provider.

Under these programs, the particular services to be provided and the number of hours of paid services are described in a written agreement, usually called a plan of care, developed with the individual and approved by the program after an assessment of the services the recipient of care requires and that persons existing circumstances, such as unpaid assistance provided by family or household members .

What is the significance of an FLSA employment relationship?

What is the scope of a paid family or household care providers FLSA employment relationship?

What are the requirements for the application of this special interpretation limiting the scope of the employment relationship of paid family and household care providers?

Home Care In or About a Private Home

Family or Household Relationship

Reasonableness of the Plan of Care


Additional Resources and Relevant Information

We Are Here To Serve You

DELUX Home Health Care is available in Kansas City and St. Louis areas and surrounding counties.

Delux Home Health Care is a contracted provider of CDS, a Medicaid-funded program that allows Missourians to hire their own caregivers: a daughter, son, relative, friend or previously hired aide.

You get loving care you deserve.While your loved one gets paid!

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Benefits Of Private Duty Vs Medicare/medicaid Home Care

As a care provider, working on a private-pay basis offers many advantages. Private duty home care agencies have complete control over their margins, which makes this service delivery model far more appealing than working as a government-contracted agency.

Private duty home care agencies are also free to offer a broad range of non-medical services to their clients, such as homemaking, companion care and ongoing personal care, regardless of whether or not the client is recovering from an injury or illness. Additionally, home care agencies are able to provide around-the-clock care upon request, which can mean increased revenue and better service delivery for clients who want to use home care services as an alternative to a senior care facility.

There are also financial benefits to take into account. Its a common misconception that not servicing Medicare/Medicaid can remove Private Duty agencies from earning profits from a larger home care market. While this may be the case for some, Nurse Next Door is a premium home care brand delivering a premium experience and our Franchise Partners are able to charge a premium price to provide it. When you consider that the profit margins on Medicare/Medicaid arent as substantial as some may believe, and that private duty home care agencies are able to set their own pricing, its clear that working on a private-pay basis can also have its financial advantages.

Types Of Services In Your Community

Home and Community Based Services (HCBS)

Many communities have services just for seniors and other people who may need support to continue living independently at home. You may have to pay a fee for some of these programs or you may find there is funding available. Some of these services are offered only in larger communities. You can find:

  • adult day programs including social, fitness and other healthy activities
  • transportation services for people who dont have public transportation or need help to use it
  • community hospice services including counselling, support groups, yoga and art classes, grief support
  • residential hospices where end-of-life care is provided in a home-like environment for those who can no longer stay in their own homes. People in residential hospices receive a wide range of palliative services to keep them comfortable.

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