Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Non-Personal Care Services

10/29/2010

Relatives--including legally responsible relatives--may be hired to provide non-personal care services when they are difficult to obtain from other sources. The rules that pertain to paying relatives to provide non-personal care services are not substantially different from the rules for obtaining such services from other sources. The relative must meet whatever provider qualifications the state may have established and charge no more than any other provider. For example, if a minor child has extensive medical needs and requires skilled nursing services, a parent who is a licensed nurse could provide the service as long as she or he meets the state’s provider qualifications.

Within the broad parameters of Federal policy, it is up to states to define the particular circumstances under which relatives will be paid to furnish services to participants. States can take various factors into account, including the availability of other sources for the same services, costs of family member services versus costs of purchasing such services from conventional sources, and specific circumstances with respect to participants. See Box for Minnesota’s provisions regarding payment of family members.

Minnesota’s Family Payment Policies65

Minnesota does not allow legally responsible relatives (i.e., spouses or parents of minor children) to be reimbursed for personal care, which they are legally obligated to provide to a spouse or child.

Additional provisions are available under the consumer-directed community supports waiver service to allow spouses and parents of minor children to provide “personal support services”--within state-set limits in hours, rate of pay, and scope of tasks.

The State allows services provided by other relatives or friends to be reimbursed only if:

  1. they meet the qualifications for providers of care,
  2. the State has strict controls to ensure that payment is made to the relative or friend as providers only in return for specific services rendered, and
  3. adequate justification exists for the relative or friend to provide the service (e.g., lack of qualified providers in remote areas). Medicaid payment may be made to qualified parents of minor children or to spouses for extraordinary services requiring specialized nursing skills that they are not legally obligated to provide.

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