Home Care Services Through Medicaid

by | Mar 8, 2024 | Long-Term Care, Medicaid | 0 comments

Homes Care services older woman and daughter sitting on couchBeing a family caregiver can be a real gift to your loved one.  Often care provided by family allows your loved one to remain at home much longer than he or she might without your help.  However, juggling your own job along with the time needed to provide home care services for your loved one can be tenuous.

Medicaid

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. Fortunately, Indiana’s Medicaid program has included a home care benefit for a number of years.  In addition, the Indiana Medicaid program will even pay family members 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. The waiver program in Indiana that most aging and disabled individuals qualify is the Aged and Disabled Waiver.

Fortunately, financial help is available in Indiana as part of the state Medicaid program’s “waiver services.”   The waiver program in Indiana that most aging and disabled individuals qualify for is the Aged and Disabled Waiver.  Two services under Indiana Medicaid’s Aged and Disabled Waiver services which compensate a family caregiver are Structured Family Caregiving and the Self-Directed Care program.

What is the Indiana Aged and Disabled Waiver?

The Aged and Disabled (A&D) Waiver allows individuals who are aged, blind, or disabled to remain in their home as an alternative to nursing facility placement. Home and community-based services (HCBS) are provided through the A&D Waiver to supplement informal supports for people who would require care in a nursing facility if HCBS or other supports were not available.

To qualify for the Aged and Disabled Waiver, an individual must first pass a medical screen conducted by the individual’s local Area Aging Agency and meet “nursing facility level of care” criteria.  The individual must then have income and assets below program limits.  An elder law attorney can assist with the medical screen process and establish a legal plan to protect assets and bring income and assets below program limits.

Getting Paid as a Family Caregiver Through Medicaid

Caring for an ailing family member is difficult work, but it doesn’t necessarily have to be unpaid work. There are programs available that allow Medicaid recipients to hire family members as caregivers.  Medicaid’s program began as “cash and counseling,” but is now often called “self-directed,” “consumer-directed,” or “participant-directed” care. In Indiana, it is referred to as “self-directed” care.

The first step is to apply for a Medicaid waiver.

The Area Agency on Aging that services the area in which the applicant resides conducts an assessment to determine the recipient’s care needs—e.g., how much help the Medicaid recipient needs with activities of daily living such as bathing, dressing, eating, and moving. Once the assessment is complete, the state draws up a budget, and the recipient can use the allotted funds to pay for goods or services related to care, including paying a caregiver. The assessment process can take weeks; so, the applicant should begin as soon as the need for services arises.

The next step is to apply for Medicaid benefits.

For individuals who have assets or income in excess of eligibility limits, a legal plan to preserve assets and overcome the income limit will need to be implemented prior to the application for benefits.  An elder law attorney can provide assistance in creating and implementing such a plan.

Recipients can choose to pay a family member as a caregiver, but not all family members are allowed. For example, the State of Indiana prevents caregivers from hiring a spouse.

Self-directed care is one of several ways a family member can receive compensation as caregiver.  With a Care Agreement that meets Medicaid criteria, the ailing family member can pay family caregivers with monthly income not otherwise used for other expenses.  Also, certain family caregivers can be further compensated for caring for the ailing family member through opportunities to give the family home or other real estate interests to the family caregiver without penalty under Medicaid transfer rules.  In some situations, a reverse mortgage can also provide additional financial support to pay for additional care in the home.

What is Structured Family Caregiving?

Structured Family Caregiving provides financial and support services for family caregivers who live with the care recipient.  A “family caregiver” is typically a relative of the care recipient, but the caregiver does not have to be related.  It can be a friend or neighbor.  As of February 1, 2020, a spouse of the recipient can be a caregiver.  For most waivers, the legal guardian or parent of a minor child CANNOT be a compensated caregiver.

Under the Structured Family Caregiving Program, the Family Caregiver is essentially “hired” by a third party who maintains payroll, registration, and other employer responsibilities.  This frees up the family caregiver’s time to concentrate on the delivery of care.  For more information about how the program operates see Caregiver Homes by Seniorlink.

The family caregiver, then receives a monthly tax-free stipend which ranges from $900 to $1,900 per month depending on the care needs of the care recipient.  The stipend can be paid to one caregiver or shared among multiple caregivers.

What are eligibility requirements?

To qualify for the Structured Family Caregiving program, an individual must meet the following requirements:

  • Be eligible for the Medicaid program. For more information about the Medicaid eligibility requirements, click here.
  • Be eligible for the Medicaid Aged and Disabled Waiver or Program of All-Inclusive care for the Elderly (PACE). To start the process to become eligible for these services, contact the Area Aging Agency that serves the care recipient.
  • Reside with the primary caregiver.
  • Require assistance with at least 3 activities of daily living (bathing, dressing, eating, ambulation, or toileting).

What is Self-Directed Care?

Rather than use a third party to provide Medicaid funded care, waiver recipients can hire their own attendant care providers for home care services under the waiver’s self-direct care program.  The recipient is the employer, but a fiscal intermediary provided by the state provides training, maintains records of hours worked, processes payroll, handles tax payments, and assists with obtaining criminal history checks of prospective employees.  As of February 1, 2020, a spouse of the recipient can be a caregiver.  For most waivers, though, the legal guardian or parent of a minor child CANNOT be a compensated home care services caregiver.

The Medicaid recipient determines how to spend the Medicaid funds allocated to his or her care, whether it be one individual or multiple individuals.

What are eligibility requirements?

To qualify for the Structured Family Caregiving program, an individual must meet the following requirements:

  • Be eligible for the Medicaid program. For more information about the Medicaid eligibility requirements, click here.
  • Be eligible for the Medicaid Aged and Disabled Waiver. To start the process to become eligible for these services, contact the Area Aging Agency that serves the care recipient.
  • Require assistance with at least 3 activities of daily living (bathing, dressing, eating, ambulation, or toileting).
  • Enter into a written Caregiver Agreement with the caregiver(s).

Are there requirements for a family member to become a caregiver?

To be a caregiver, an individual must meet the following requirements:

  • Be 18 years of age or older.
  • Pass a criminal background check.
  • Be deemed physically and mentally capable of performing his or her caregiving responsibilities.
  • Compose daily notes of care provided.

Other Home Care Services and items under Indiana Medicaid Aged and Disabled Waiver

Home care services that Medicaid may pay under the Aged and Disabled Waiver include the following:

  • In-home health care
  • Personal care services, such as help bathing, eating, and moving
  • Home care services, including help with household chores like shopping or laundry
  • Caregiver support
  • Minor modifications to the home to make it accessible
  • Medical equipment
  • Respite Care

Besides home care services, the Aged and Disabled Waiver also covers the following alternatives to nursing home care:

  • Adult Day Care
  • Adult Family Care
  • Assisted Living Care

For other ways for family caregivers to receive compensation-including other Medicaid programs and VA pension, click here.  The Stinson Law Firm has extensive experience assisting families with obtaining financial assistance for home care services, including compensation for family caregivers.  Please do not hesitate to contact us at 317-622-8181 or info@stinsonlawfirm.com to start your plan for covering home care services today.

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