Feature Article Continued From Home Page
Waivers to federal Medicaid policy allow Medicaid funds to be used for what we call non-traditional services, or those services that assist a person to remain out of an institution, i.e. nursing home, while using Medicaid dollars to pay for community oriented services. This applies to anyone who is disabled, 18 years of age and older and who would otherwise qualify to be placed in a nursing home.
A variety of services are purchased for persons who are cared for through benefits under Medicaid waiver programs. These services include:
a. Adult Day Health Care
b. Chore Services
c. Counseling
d. Environmental Accessibility Adaptation
e. Home Delivered Meals
f. Homemaking
g. Personal Care
h. Personal Emergency Response Systems
i. Nursing Facility Transition services
j. Non-Medical Transportation
k. Private Duty Nursing
l. Respite In-Home
m. Respite Out-of-Home
n. Specialized Medical Equipment and Supplies
o. Training Services
Often these services can be combined into an effective and well rounded plan of care that can help a person to remain in their own home or at least in a more community oriented option, i.e. 6 or 12 bed small scale assisted living. A mix of home care, usage of an adult day healthcare program multiples time per week, transportation to certain appointments, etc. can give a person what they need to maintain a degree of independence.
The best part: it generally costs less than what nursing home care does. How does a person become enrolled in a waiver program?
Generally the person has to be assessed after a phone intake by a waiver agent. A waiver agent is an organization who verifies enrollment qualifications for each referral, writes a plan of care and arranges and monitors the delivery of services.
Typically this is an area agency on aging or other non-profit organization with a history of providing family oriented/human services to the community. A nurse and social worker conduct the assessment to determine medical and financial eligibility for enrollment into the waiver program.
As I look back to my days as a waiver provider I can tell you stories of hundreds of people that our organization (Friendly Human Services Group) served who without us or an equivalent program would have been placed in a nursing home.
A good example would be Ms. Louise Jones. Ms. Jones suffered multiple strokes and was dealing with a degree of dementia. She was wheelchair bound. She was living with her niece who was also a single mother of 3 children. Ms. Jones came to our adult day health care program 5 days per week, she was in our overnight respite program 4 nights per month and we supplied an aide in their home for 8 hours every other Saturday. This plan of care was designed to keep Ms. Jones out of a nursing home and to provide relief for the niece.
How does the expense compare with a nursing home stay?
Total bill: $1,132.00 Adult Day Health Care
232.00 Home Care
389.48 Out-of-Home Respite
Total cost back in 1996: $1,753.48 per month. Would you not agree this is much less than the average $211.00 per day nursing home cost in America?
Providers come from a variety of business models. This includes adult day health care centers; those programs that provide companionship, nutritional management, medication management, physician intervention and rehabilitation along with personal care in an organized way during the day so caregiving relatives do not place their employment in jeopardy while caring for a loved one.
Add to the list home care companies, case managers who coordinate transition from skilled nursing centers, transportation companies, professionals including social workers and nurses who provide training to families and waiver enrollees who are coping with new medical conditions and more.
How do providers become vendors: Providers must complete the enrollment process with a waiver agent. The process would ordinarily include submitting a program that details how you execute services in accordance with rather strict service standards. These standards are often developed by each state’s Office of Services to the Aging.
You must have the required insurances in place including professional/general liability, workers compensation and an employee dishonesty bond listing the waiver agent as an additional insured. In addition, for out-of-home respite providers, surely the waiver agent would inspect the home or facility to be used for overnight stays. I have learned that most waiver agents also want the home to be licensed.
Some waiver agents want the provider to have been in business for at least 3 years which I imagine assures a degree of financial and operational stability. For professionals the obvious proof of credentials is needed.
I like the way waiver agents typically do business. I have observed no concrete evidence of contract award corruption and lots of the rumors you hear coming out of how some of the mental health networks do business is not present with waiver agents. That is reassuring on multiple levels.
They have high standards and make a concerted effort to spread the business around through their direct purchase of service process. Of course client choice is also paramount in selecting service providers.
Waiver agents in SE Michigan whom a service provider may wish to contact regarding doing business now follow.
Waiver Agents in SE Michigan
a. Detroit Area Agency on Aging (Area 1-A)
Serving Detroit, Harper Woods, Hamtramck, Highland Park, All 5 Grosse Pointes
1333 Brewery Park Blvd # 200 ● Detroit, MI 48207-4544
(313) 446-4444 ● Web: www.daaa1a.org
b. Area Agency on Aging 1-B
Offices in Multiple Counties
Serving Michigan Counties: Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw
AAA 1-B, continued:
Main office: 29100 Northwestern Highway, Suite 400 ● Southfield, MI 48034
(248) 357-2255 ● (800) 852-7795 ● TTY: (248)-263-1455 ● Fax: (248) 948-9691
Web: www.aaa1b.org
c. Area Agency on Aging 1-C ● The Senior Alliance
Serving Western and Southern (Downriver) Wayne County
3850 Second Street, Suite 201 ● Wayne, MI 48184
Phone: (734) 722-2830 ● (800) 815-1112 (S.E. Michigan only)
Fax: (734) 722-2836
Web: www.aaa1c.org
d. Macomb-Oakland Regional Center
Serves same area as Area Agency on Aging 1-B
16200 Nineteen Mile Rd. ● Clinton Township, MI 48038
(586) 263-8700 ● Web: www.morcinc.org
e. The Information Center, Inc.
Serving same area as Area Agency on Aging 1-C
20500 Eureka Rd # 110 ● Taylor, MI 48180-5370 ● (734) 282-7171
Web: www.theinfocenter.info
Waivers to Medicaid programs, authorized by the U.S. Secretary of Health & Human Services have helped millions of people avoid institutional care. This includes many young persons with serious disabilities and those affected by accidents who could not claim benefits under their state’s no-fault laws.
Responsible providers have been able to see their business models expand and grow as a result of this additional revenue source. Two that I have personally mentored who are now serving waiver clients include God’s Caring Hands of Redford, MI and Hidden Treasures Residential Care in Belleville, MI. I congratulate them both and wish them continued success.
One of my favorite waiver agents is the Mid-Florida Area Agency on Aging. Their website is a major source of important information. On the web you can find them at: www.mfaaa.org.
One of my companies, Direct Care Training & Resource Center, LLC holds informational events which educate providers on the waiver process. Details can be located on-line under Special Events at www.directcaretraining.com.
Providers will have a special opportunity to showcase themselves during the 2009 “Caregiver’s Information Forum” being held at the Dearborn Inn on Saturday – November 14th, 2009. I hope I can count on seeing you there. For more details please contact Tiffany in my office at 248.987.6842.
Blog about it here at www.americancarenews.com, read about it in the next few issues of American Care News. Did you take the time today to subscribe?
