For a multitude of reasons, even once approved for Medicaid, many families have been hesitant to move their loved ones to an Assisted Living or Nursing Home environment, opting instead for home care. However, home care through an agency comes with issues of its own, primarily rooted in staffing shortages. It is no secret that the United States’ aging population is growing, an impending crisis exacerbated and exposed by the COVID-19 pandemic. The Philadelphia Inquirer recently called out Pennsylvania’s lack of comprehensive eldercare solutions, rating their “level of preparedness at a ‘C’ or ‘D,’” not nearly good enough to match a “public health crisis of epic proportions.” For those who have friends and family to assist with caregiving and care management, now may be the time to look to some “historically underutilized” benefit programs that may be a good fit.
In Pennsylvania: Services My Way
If you or your loved one have already been approved for Medicaid’s Long-Term Care waiver at home in Pennsylvania, you can request to be enrolled into the Services My Way (SMW) program. This program allows the Medicaid recipient to become the employer and self-direct their own services, including selecting and hiring a caregiver of their choosing. SMW allows participants to choose a family member, friend, or existing participating caregiver. Their Medicaid service coordinator assists participants in creating a care plan and developing and managing their self-directed services. While the chosen caregiver cannot be an appointed Guardian or Power of Attorney, the participant can request their Guardian or Power of Attorney be appointed as representative to assist with managing the approved budget and monitoring the caregiver’s hours and payroll.
In New Jersey: Personal Preference Program
Once approved for Medicaid’s Long-Term Services and Supports at home in New Jersey, individuals can enroll in the Personal Preference Program (PPP). Similar to PA’s Services My Way, PPP provides an alternative to agency-directed services and allows the participant to hire a friend, family member, or existing participating caregiver of their choosing. They also offer financial counseling services to the participant or their representative (Guardian or Power of Attorney) to assist in determining how the monthly budget will be managed. This allows participants to create a more personalized care plan to meet their needs and eliminates the necessity for agency-directed care providers.
By taking advantage of the above programs, it may be possible to circumvent some of the caregiver issues many are experiencing. However, please keep in mind when considering the above options, Medicaid has its own application process with specific clinical, income, and asset requirements. Additionally, because both programs shift the burden of locating, hiring, and overseeing the caregiver’s hours, budget, and payroll, back to either the Medicaid participant themselves or their representative, these programs may not be a good fit for every circumstance. Once approved for Medicaid, your team at Rothkoff Law Group can help you to determine if either program is appropriate for you and your needs.
