“Medicaid Waiver” What is it? Do I qualify? How do I get started?

Posted on August 14, 2018 by lawp873

The name waiver comes from the fact that the federal government “waives” Medical Assistance/Medicaid rules for institutional care in order for Pennsylvania to use the same funds to provide supports and services for people closer to home in their own communities.

When trying to pay for senior home care the Aging Waiver is where a lot of people focus. The Aging Waiver is designed to help people who are age 60 and older who have been assessed and require services at the level of nursing facility care, needing assistance with activities of daily living (ADL’s) and have a financial need. If an individual qualifies physically and financially the Aging Waiver provides funds to pay for in-home care.

In Pennsylvania, the Department of Human Services administers multiple Medical Assistance/Medicaid waivers. Each waiver has its own unique set of eligibility requirements and services.

Waivers offer an array of services and benefits such as choice of qualified providers, due process, and health and safety assurances.

Currently, Pennsylvania has many waiver programs that are designed for specific needs including:

Aging Waiver
Attendant Care Waiver
Independence Waiver
OBRA Waiver
Act 150 Waiver

The First Step:

The first step in applying for the Aging Waiver is to contact Pennsylvania’s Independent Broker (PA IEB)

The IEB will provide the path you need to follow to determine financial eligibility and physical eligibility. If you qualify the IEB will provide you a list service coordinators you will choose from and they will provide you with a list of home care agencies to choose from. Then you can begin home care. The Team is made up of three parts: you, the client, the Service Coordinator and the Home Care Agency. You the client have the ongoing option to change and choose different Service Coordinator and Agency to best fit your needs. For example, if you are working with an agency that you are not happy with you can switch to Loving Arms Elder Care who is an approved Aging Waiver provider.

A decision about whether you qualify will be sent to you within 90 days after PA IEB starts your waiver application. If you do not get a decision within 90 days, you can ask for a fair hearing.


Senior Home Care Agency or Registry?

Originally Posted on August 31, 2018 by lawp873

The thought of senior home care can be daunting. Many families are thrust into the home care maze when a loved one has an unexpected fall or surgery. Suddenly, important decisions need to made very quickly. This post will help to streamline the options and help families make informed decisions about senior home care.

Essentially there are three different options to consider:

The agency model (Loving Arms Elder Care)
The registry model (Home Care Connect, or Care.com)
Private hiring

Agencies make things easy. They have a pre-screened staff of trained caregivers. They can usually begin care at a moment’s notice and they handle all the things you are not even thinking about like payroll, insurances, and scheduling. When choosing an agency look for length of time in business, fees and the process they use to match clients and caregivers. This service comes at a premium though. Agencies may not be an affordable option for every family.

The registry model can be more economical than an agency. You will most likely save 25% or more when compared with typical agency fees, but the savings comes from your willingness to do some of the work on your own. Registries offer lists of caregivers in your area. It is usually your job to contact, interview and set up the care schedule. You may need to do some in-home training and make plans for the eventual call-out situation. Many registry sites offer safety net services like background screenings and complete payroll services. Much of this work can be completed online and can be shared with different family members. When using a registry, look for companies that offer local representatives that can guide you through the process.

Private hire is very prevalent but is the model that requires the most work. It can begin innocently, a nice woman from church agrees to care for your mother in her home. But have you considered things like: work eligibility, background checks, references, drug testing, payroll taxes and liability insurance? (Bartelstone,2018) Private hire works wonderfully until it doesn’t. What if the care suddenly increases? What if someone gets hurt? What if your caregiver suddenly finds themselves out of a job and they file for unemployment? These are real concerns that can end up costing much more than you are saving. Consider consulting a local elder law attorney for advice before hiring privately.

It’s a lot to consider. How can you possibly make the best decision for your family? First, have the conversation before you are forced to have it. Ask questions about what in-home care might look like. Find out how will you pay for the care. Is there a long-term care policy? If so take a look at it, understand what your options are. You are not alone. There are many professionals in your local community who are ready and willing to help. “Professionals including social workers, care managers, nurses and those at community agencies working together will ensure that the burdens of receiving care don’t compound the existing challenges faced by the family.”(Bartelstone 2018)

Bartelstone, Rona. (2018). Case In Point: Hiring In-home Caregivers. CSA Journal,70(1),68Bartelstone, Rona. (2018). Case In Point: Hiring In-home Caregivers. CSA Journal,70(1),70
CSA Journal
Alice Jacobs, CSA
Loving Arms Elder Care / Home Care Connect