Case Studies of Six State Personal Assistance Service Programs Funded by the Medicaid Personal Care Option. IV. Service Limits


A. Total Services Allowed Per Consumer

Services are capped at $333 per person per month. It is possible for an individual to receive "expanded home help" if the adult service worker documents the additional need through a special (and apparently time-consuming) procedure. Exceptions up to $999 per month may be approved by the county supervisor. Requests for exceptions above this amount must be sent to the state office for approval. Some people who are ventilator users get $2000 per month for 24 hour PAS (as opposed to $8000/month for special nursing home reimbursement). There are roughly 1800 exceptions statewide.

B. Type of Services Offered

1. Paramedical Services

Attendants are allowed to assist with self-administered medication, but other paramedical services cannot be provided by the attendant. Home help may be coordinated with home health services, so that periodic nursing visits, physical therapy and home health aides may be provided in the home.

2. Emergency and Respite Services

Respite and emergency services are not a regular part of the home help program. This is seen as a real shortcoming by consumers and a disincentive to moving out of congregate housing: those who live in congregate housing can ask attendants of friends to help out when an attendant doesn't show up, but those living independently have problems.

3. Homemaker Services

Light housekeeping are a part of the personal care services billed through Medicaid, and heavier "chore services" may be provided through state funds. Chore service funds are limited, however, and may be eliminated in the near future.

4. Supervision

Supervision is not a covered personal care service. In some cases, the fact that family members in the consumer's home may be paid for personal care allows the consumer to receive the necessary supervision from the relative as well.

C. Location of Service Provision

Home help can be provided in individual homes, board and care homes, and small group homes. Medicaid personal care funding is also accessed for adult foster care and homes for the aged, but this is not part of the Home Help program (see section VIIA for a further discussion of Personal Care in these settings).

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