Financing/Coverage

How to Apply for Medicaid in Pennsylvania?

Welcome everybody to the Wellsprings Home Care Podcast. I’m your host, Justin Currie, my two four legged co-hosts are not with me today even though we’re working from home during this quarantine.  

I wanted to jump into announcing our Best of Home Care Award because we’re still really excited about it. SeniorAdvisor.com actually gave us one of the 2020 Best of Home Care Awards. And what that is, is that it actually recognizes the top 2 to 3% of home care agencies nationwide. So we’re obviously really excited and really proud to receive that award, and we’re really happy we have such a great team on board and great caregivers and great clients. And just for those of you who don’t know, we are a Non-medical Home Care service provider and we’re based in Exton, Pennsylvania and we serve the counties of Chester, Montgomery, and Delaware County in Pennsylvania. 

Some of the services we offer here at Wellsprings are Personal Care. So things like toileting, bathing, Personal Hygiene Services being tasks like oral care, oral hygiene, incontinence care and shaving.  

We also have caregivers that are specifically trained in Dementia and Alzheimer’s. So they’re able to come in and track progress and or decline, depending on the situation. They’re really helpful to have in the home. 

One of the other things we offer is Companionship. So if your loved one just need somebody to talk to, we can either do that by telephone or we can have somebody come in and just be a friend and be there for them.  

Mobility Assistance is another service we can offer, so if somebody comes home from skilled nursing maybe they’re there and rehabilitation will actually help them. We’ll do full transfer assists right up to standby assist where they’re just maybe not as sure of their balance as they once were. So we’ll come in and help out and just sort of help them build that confidence back.  

So what we’re going to be talking about today is How to Apply for Medicaid in Pennsylvania. For those of you that don’t know, Medicaid in the U.S. is actually a state and a federal program and it really helps out people with limited resources and limited income, and it can offer benefits to pay for things like home care.  

So before we jump into how we can apply for Medicaid, I want to talk a little bit about individuals who are automatically enrolled. The state PA rolled out a program called Community Health Choices. And what that is, is it’s Medicaid falls under that banner. And because of the change, there’s people that you know are currently getting services that will automatically be approved for Medicaid waivers. The number one reason is somebody who is receiving both Medicare and Medicaid, they’re automatically enrolled in community health choices. Somebody who’s receiving long-term Social Security in the Attendant care, Independence, Comcare or Aging waivers, they’re automatically enrolled in Community Health Choices. Somebody who is receiving services as per the OBRA waiver and also clinically ineligible to be in a nursing facility. Also Anyone who is receiving care in a nursing home that is paid by Medicaid, they’ll automatically be enrolled in community health choices. And also anybody who participates in the ACT 150 waiver who is both eligible for Medicaid and Medicare, that individual will also be enrolled in community health choices. 

So those are some of the ways that someone can automatically be enrolled and that’s sort of like I guess grandfathering in, they were already a part of certain programs before Community Health Choices was rolled out so they’re automatically enrolled.  

Now I just want to state also individuals that would not be eligible for CHC (Community Health Choices). So if you fall under any of these four items then you would not be able to apply for a Community Health Choices waiver with Medicaid.  

  1. Someone who is receiving long-term social security under the OBRA waiver  
  1. Are not nursing facility eligible.  
  1. An ACT 150 program participant who is both eligible for Medicaid and Medicare. 
  1. Anyone who is in a state operated nursing facility including the state veterans homes. 

So any individuals that fall under those, those four items are not eligible for community health choices. 

So now that we’ve discussed ineligibility, I just want to jump into some of the different ways that you can actually apply for Medicaid. There are four different ways that someone can apply for Medicaid: 

  1. OPaper – You can actually download an application. So if you go to dhs.pa.gov and you follow the tabs to medical assistance, then you can actually download an application there and submit usually by fax. 
  1. IPerson – You can actually contact your County Assistance Office and you can do that by just kind of doing a quick search online for your CAO, which is your County Assistance Office and there’ll be an address there that you can actually go to and talk to them and you know, they’ll help you apply that way. 
  1. BTelephone – Call the Consumer Service Center for health coverage and the number for the Department of Health in Pennsylvania is 1-866-550-4355 and you can chat with them and they’ll kind of guide you through the process. 
  1. Online Application – Just go to https://www.dhs.pa.gov and they’ll guide you through the process on there but you might want to help have a family member or someone else help out. 

You can call us, we can help you guide through the process as well and applying for any Medicaid waiver, it’s like any insurance program, it is a bit of an arduous process. It’s gonna take some time. It’s gonna take a lot of paperwork off the start digging through some of your old records providing assets, incomes, things like that. So it does take some time to get started, but once you have that information and you have that approval, it’s a very good benefit to be on because some Medicaid waivers, they can be fairly long-term and they can help out for a long time. They’re definitely beneficial to somebody that does have that limited income. They can have somebody come in there and help out and they typically adjust hours according to the health background of the individual. So if you do see any decline or you know throughout the term, then you know, they’re likely to add more hours as well. 

Medicaid is definitely a worth putting in the time and effort off the start and Wellsprings Home Care and our affiliates can help out with that as well. We’re a Medicaid approved provider and we’re approved for all three MCOs. So that’s Keystone first, UPM, CPA Health and Wellness – any MCO (Managed Care Organization) that the beneficiary picks, we can provide care services for.  

So that’s about all the information I have on how to apply for Medicaid in Pennsylvania, I really hope that helps guide some people through the process. I know it can be tricky, especially when you’re not that tech savvy. Even myself, I struggle with that a little bit as I’m sure most people do but we’re definitely here to help.  

Get in touch with us anytime at www.wellspringshomecare.com and our phone number is 610-463-0880 and we can help you out anytime. So thanks a lot for stopping by and we’ll see you next time! 

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Funding In-Home Care for Seniors in Chester County

In our experience providing senior home care to families in Exton, West Chester and Downingtown, we know that it can be extremely overwhelming when a loved one goes into the hospital, they’re discharged from a skilled nursing facility, or they have a fall and they’re in need of immediate assistance at home. A lot of families don’t really know where to turn or how to fund in-home care. Luckily there’s a lot of different options out there for families, but unfortunately without the proper knowledge, you’re not really sure where to turn to next.

For those of you that don’t know, home care is where we bring in a non-medical home care aide – this can be a direct care worker, it can be a CNA (a certified nursing assistant) or an HHA (a home health aide). We also have LPN’s on staff as well that come in and help out.

Now, this can be a real financial burden to families, especially if they’re caught by surprise. Here, we’ll going to help you navigate your options to afford in-home care.

Private Pay: The number one option to pay for home care is private pay. A lot of families have savings or they have a family member that’s able to help out, or leveraging any annuities, stocks or bonds. But there are a lot of other options as well. We’ll jump into veteran pension.

Veteran’s Administration: If you were a veteran or a surviving spouse of a veteran, there is a good chance that you may qualify for funding from the Veteran’s Administration. There are a lot of requirements to meet. Usually the individual that needs care has to be age 65 or older, totally or permanently disabled, or a patient in a nursing home receiving skilled nursing care, receiving social security or disability insurance. There’s a lot of asset limits and income limits as well. There are three different veteran benefits.

  1. The first being the Aid And Attendance Benefit that pays for home care – that’s probably one of the best benefits that a veteran can get is because it’s typically around $2,600 per month in paid home care services. So, while it can be really helpful, the prequalification requirements are pretty stringent.
  2. The second option is Basic Improved Income. That’s a very rare benefit. We don’t see that often here, but it is an option.
  3. Last is a Housebound Benefit. Typically, housebound benefits, they only allow for roughly two hours per day of care. For a veteran’s benefit, you definitely want to look to the aid and attendance benefit first if anything at all.

Long-Term Care Insurance: Another really good option is long-term care insurance – a lot of families are unaware that their loved ones or their parents or their grandparents policies actually will pay for the cost of home care.

If you’re looking for care for someone or even for yourself, the first thing you’d want to provide your long-term care provider is the policy number and the last four digits of your social security number and they can provide you with all the info you need and if nonmedical home care is covered by the long-term care insurance.

Reverse Mortgage or Home Equity Line of Credit: Now, this would be if you’ve built up equity in your home over time, you can talk to your talk to your bank or whoever provided you the loan. It’s an option to pull out that equity to pay for a home care services.

Life Insurance Policy: Home care coverage which will depend on the on the provider of the policy – different policies have different requirements, different qualifications.

Social Security: Social security is not going to offer a whole lot generally, as this is what the seniors are collecting from the government that’s being paid over the years.

Home Care Loan: This is more common for a younger family member to take out a home care loan to help out their parents.

State Programs: Two of most common state program in our Chester County area would be Chester County Department of Aging. For more details and options, go to their website at www.cheso.org. But unfortunately, the hours are very low, and the approval process can take some time. Sometimes it can be up to up to two, three, four months to get approved and typically clients are only getting two to three hours of care a couple times a week.

Options Program: Similar to a state program, this is typically going to be very low hours of care with a somewhat longer applications process.

Medicare Advantage: As of January 1st, 2019, Medicare Advantage started paying for non-medical home care services. But, because they don’t really have the budget for it yet, it wasn’t really rolled out until January 1st of 2020. Obviously, they need the funds to fund the home care, and now we’re a few months into 2020, as a home care owner, I still have yet to see Medicare Advantage paying for anyone’s home care services. I’m sure there are instances where they are, but it is, it is very rare. I think this will be an excellent option in the future. The second last one here is going to be Medicaid. So Medicaid, it’s, it’s, it’s called the home and community based services waivers. So there’s a, there’s a lot of different waivers that you can apply for in Medicaid. It’s, it has to do with lower income individuals, but it’s a very helpful program.

With Medicaid, traditionally you can get a lot of hours. We have some clients that are up to 20 to 24 hours a day care. So, Medicaid can be very helpful in those situations where it isn’t a low income individual. The only downfall is that it does take a long time to go through the process and application, as with almost any type of insurance. It’s definitely good to start looking at that option early and then you can at least get the process done. So when the time does come, you know, you can get the information and the care you or a loved one needs quickly.  

Life Living Independence for the Elderly: This is another program that has very, very strict requirements and fairly low hours. At WellSprings Home Care, we’ve only had one client in the past utilizing this option, and that’s do to it’s very low hours.

In conclusion, your best options for paying for home care either going to be private pay, leveraging that Veterans Administration if that’s an option, as well as Medicaid – especially for lower income individuals. And if you do happen to be over the asset limit with Medicaid and it’s not an option for you immediately, you can actually ‘spend down.’ Essentially, Medicaid can become an option for you when your income cross a specific threshold. Once you are at that point of income, that’s when a Medicaid will actually kick in to assist.

Don’t let cost hold you back from getting the care you need – there are many options available to assist. If you have any questions, or would like to further discuss which options might be best for you or your loved one, please contact Justin Currie at WellSpringsHomeCare.com or at 610-463-0880.

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Veteran’s Guide to Qualifying for Home Care

Veterans home care

Finding the right home care for veterans can be difficult. At WellSprings Home Care, one of our biggest goals is to help our senior veterans find the home care solutions that align best with their needs – and for many families, this means finding the right financial solutions.

Many Chester County, Montgomery County, and Delaware County veterans may be unaware of their home care benefits, which means that they could be paying more for homecare than they should. That’s why we’ve created this guide for veterans on qualifying for home care.

Benefits as a Veteran

There are several options to pay for homecare as a veteran. While these options do have some qualifications to meet, you might be surprised to know that more than one-third of senior veterans are unaware of their choices. Let’s take a look.

• VA Pension. U.S. military veterans and widowed spouses of veterans can receive supplemental income through the VA’s Veterans Pension and Survivors Pension benefit programs. While these benefits are needs-based, this is certainly a great option to explore further.
• Housebound Benefits. Veterans who are unable to leave the house due to health issues or disability may be able to receive housebound benefits through the VA. This can also include if assistance from another person is needed to leave the house for doctor’s appointments, or other necessary medical visits.
• Aid & Attendance. If your loved one qualifies for a VA pension and needs assistance from another person, he or she may be able to receive Aid & Attendance. This program provides additional income on a monthly basis, and essentially can help pay for homecare services.

Who is Eligible for VA Benefits?

The next question to ask is if your loved one is eligible for VA benefits. In general, qualifying veterans have served a minimum of 90 days of active duty, with one or more of those days during wartime.

Other requirements include:
• Age 65 or older with limited income
• A nursing home patient
• A Social Security Disability Insurance recipient
• Permanently disabled

More specific requirements pertain to the Aid & Attendance and Housebound benefits. These include determining everyday activities, or activities of daily living, your loved one needs assistant with. Such activities include personal hygiene routines, meal preparation, household chores, and taking medication.

What are the Financial Eligibility Factors for VA Benefits?

Financial eligibility is also something to consider when applying for VA benefits. Your loved one must have an income below the amount set by Congress. This includes income from disability and retirement plans, net income from a personal business, or interest from annuities.

Additionally, your loved one’s assets will also determine if he or she is eligible for benefits. This is decided on a case-by-case basis, where the VA will look at an individual’s assets and determine if he or she could live off of them for a sufficient amount of time.

Learn More About Veterans Qualifying for Home Care

While we’ve put a lot of information in here about how veterans can qualify for home care, there’s still much to learn. Contact us at WellSprings Home Care Services at (610) 463-0880 with all of your VA Pension questions, and we’ll be happy to help!

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Understanding Your Coverage: Does Medicare Pay for Home Care?

If you or your elderly parent or relative is in need of home care, you may be wondering if it’s covered under his or her Medicare plan. Our team at WellSprings Home Care Services has the answers right here for you.

Wellsprings home care

Medical and Non-Medical Home Care

To start, let’s define what we mean by medical home care, or home health care, and non-medical home care. These terms share many similarities, but have distinct differences – especially when determined by Medicare standards.

Home health care is provided by a medical professional, such as a nurse or physical therapist. Such practices include nursing care, rehabilitative therapy, medication administration, and so on. Home health care is usually recommended by a doctor, especially right after a surgery or fall in the home.

Non-medical home care is provided by trained caregivers who are not licensed medical professionals. This care can include services such as live-in care, personal hygiene assistance, light house chores, and companionship.

What Type of Home Care Does Medicare Cover?

Medicare covers home health care, and the terms must meet specific criteria, including the following:
• Your doctor has advised medical care at home
• You need medical assistance such as nursing care, physical therapy, occupational therapy, or speech therapy
• You are unable to leave your home without assistance, also known as being homebound
• The homecare agency you’re working with is Medicare-certified

If these four terms are met, your Medicare plan will cover these types of home health care:
• Part-time or intermittent nursing care
• Part-time or intermittent home health aide services
• Physical therapy, speech therapy, and occupational therapy
• Social services such as counseling or community resources
• Some medical supplies, excluding prescription drugs and biological
• Wheelchairs and walkers

Medicare will not cover:
• Live-in care
• Delivered meals
• Personal care assisted by home health aides

In most cases, Medicare will cover the full amount of nursing and therapy services, and 80% of wheelchair and walker expenses. However, you may have to pay a coinsurance amount in some instances.

These same benefits apply if you have a Medicare Advantage plan, except that you will need to obtain services through a home health agency within the plan’s network.

In cases where you need to pay a coinsurance, a Medicare Supplement plan, or Medigap, can help to cover this amount, along with other costs not covered by Medicare Part A or Part B.

Find the Right Home Health Care Agency to Help

Not every home health care agency is certified by Medicare. You’ll want to check on this factor first, before choosing where to hire a home caregiver. Your doctor can help with recommending an agency within your network, or you can visit Medicare.gov to find a Medicare-certified agency in your area.

While Medicare will cover medical expenses within the home, it may be that you or your elderly loved one needs help with everyday tasks. Thankfully, there are several other options when it comes to paying for non-medical home services.

If you are a senior or family member of an aging loved one in the Delaware County, Montgomery County, and Chester County areas, feel free to contact us at WellSprings Home Care with your home care questions and concerns.

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