Medicaid

Good afternoon everybody, and welcome to the Wellsprings Home Care Podcast and our topic, Does Medicaid Pay for Family Caregivers? I’ll be your host, Justin Currie, and I sure hope that everybody’s keeping their sanity with this quarantine that’s going on. It’s really extending a lot longer than most people thought so I hope everybody’s keeping safe. I hope everybody has access to all the supplies that they need and as long as everybody works together, I think this can be over a lot sooner than later. So let’s hope for the best.

I just wanted to jump into an introduction of who Wellsprings is. We’re located in Exton, Pennsylvania and we serve the counties of Montgomery, Delaware, and Chester, which predominantly in Chester County area. We were actually chosen by SeniorAdvisor.com and we won one of their 2020 Best of Home Care Awards and what that is, is it’s actually they recognize the top 2 to 3% of Home Care Providers nationwide, so obviously that’s something we’re super excited about here and we want to continue to grow and continue to help out our clients and we’re going to strive for the same thing next year.

So for those of you that don’t know, we offer non-medical home care and some of the services that we offer are things like Personal Care – so toileting, showering, bathing, things along those lines as well as personal hygiene. We’ll help out with brushing the teeth and other oral hygiene. We can offer assistance with sponge bath, bed bath, incontinence care, things like hair brushing and anything along those lines.

And some of the other things we offer is our Live-In Care, which is pretty much synonymous with a 24 hour care. It’s when somebody is going to be in the home at all times.

We offer Dementia and Alzheimer’s Care. Most of our caregivers are actually specially trained with dementia, so they can come in and help out and really kind of track the track progress and decline and things like that.

We offer things as simple as Companionship. If somebody just needs a friend and we offer care to veterans and we offer benefit assistance to them as well. We can definitely check and see if somebody qualifies for Home Care services where the Veterans Administration will actually chip in and help out with the home care services.

And one of the other main things that we offer is Mobility Assistance, so anytime somebody comes home from skilled nursing discharge or maybe they’re just not quite as steady on their feet, they’re having a little bit of balance issues and things like that, we can come in and we can do everything from full assists to just as stand by assist where there’s just a concern of falling, so we want somebody there when they’re ambulating through the home.

On today’s topic we want to talk about, Does Medicaid Pay for Family Caregivers?

Obviously in a lot of situations, care’s already in place. There maybe a spouse or a family member that’s around and able to help out. Unfortunately, that becomes a little bit of a burden to the family member in a lot of situations, especially if they have a full time job that can be a financial burden as they’re typically not paid for it because a lot of families are actually unaware that there is benefits that help pay for those sorts of things. And today we’re going to be talking specifically about Medicaid and how they can help out.

So if we’re looking at the fact that the individual does not have Medicaid yet, obviously the first step would be to apply for Medicaid and then once approved, what they’d want to do is sign up for a specific Medicaid program that actually pays for home care services. And you want to also look for one that allows for consumer direction and that’s typically known as self-directed care, and that means the recipient of the benefit can actually select their care provider and that’s opposed to having Medicaid pick it for them.

So with self-directed care, there’s actually two options that the beneficiary can go with.

1. They hire their family member directly as a personal caregiver. – This would involve a lot of paperwork and a lot of effort by the family overall. So typically that’s not what most families like to do. So what would be involved in that for the family member? They would have to submit all time sheets to Medicaid claims would have to be submitted to Medicaid and everything would have to be done by the family. In addition to that, they would have to do an assessment off the start of care. So what that involves is creating a care plan moving forward and generally the Medicaid service coordinator would help out with that. There’s a lot of planning involved. You have to plan mobility assistance, what type of equipment is needed in the home. That involves maybe wheelchairs, hospital beds, things like that. And then a lot of planning just for meals, for shopping and for any activities that need to be done.

Another issue with that would be coverage. When you hire a family caregiver, typically you don’t have other coverage in place that can come and help out. So the other option that’s a possibility is obviously option 1 – is to hire the family caregiver directly where they would have to submit all time sheets, deal with any payroll taxes, things like that.

2. The second option is to work with an agency like Wellsprings. Wellsprings is a Medicaid approved provider. We provide for all three MCOs, which is a Managed Care Organization, so that includes Keystone first, UPMC as well as PA Health and Wellness.

Some of the advantages to going with an agency like Wellsprings is for first off, there’s no extra cost to the Medicaid recipient. So basically what would happen is the service authorization would go to the agency and after that everything would be under control of the agency, so the agency would actually perform the assessment and create the care plan for the individual. Any costs, things like background checks, TB testing, competency testing, all of that is required by PA State Regulation and that would all fall under the agency. So the burden of that would fall on the agency. They would incur all of those costs.

Another advantage would be full coverage and in case of an emergency. If the family member did have an emergency and they couldn’t make it into work for a day or a week or a month, anything like that, that’s where an agency like Wellsprings that has a lot of caregivers in the area is able to step in and offer coverage in those situations. So the individual would never go without care.

And another advantage would be payroll taxes. So obviously working for an agency, the family member would fall under our employee banner, which means that all payroll taxes and everything would be taken care of just like they were an employee of any other company.

One of the major things would be that when they do fall under our banner as an employee, they are fully insured and bonded. So if there was any issues in the home or anything there, they’re completely covered by our insurance or bonding and then also workers’ compensation insurance as well. So if they were hurt on the job, they would be covered by that.

Lastly, there would not be any paperwork required by the family. Everything, as soon as the service authorization came through to Wellsprings, everything would be taken care of by Wellsprings. Any of the administrative stuff, any of the dealing with the service coordinators, scheduling, onboarding the family member, things like that are all taken care of by the agency.

And the major thing on top of that would be the submitting of claims. So Medicaid typically, being in a government agency, they’re not the easiest to submit claims through. So we have a clearing house actually that submits our claims for us to them and they follow up on all claims just to make sure everybody’s getting paid. And also the caregiver does not have to wait for the Medicaid payment to come through with an agency. They would actually get paid biweekly by Wellsprings. They’d get paid on that biweekly basis regardless of whether when Medicaid paid or not. So that kind of takes that stress off, you’re getting a paycheck every two weeks. And so that pretty much wraps it up for Medicaid and payment for caregivers.

So just in summary, there is two different options with Option #1 – Being the Medicaid recipient can hire the caregiver directly who is a family member. And I should mention that in Pennsylvania that that family member cannot be a spouse or a legal guardian of the care recipient. So that’s a restriction obviously. And oddly enough, it can be an ex-spouse, it can be another family member, somebody that’s not living there – anybody else can help out except for the spouse themselves or a legal guardian. And the Option #2 – is to go with an agency which is no extra cost to the care recipient, no extra cost to the family caregiver and basically everything as far as insurance, payroll, taxes, any of the paperwork back to the incurred costs of the background checks and TB screenings is all covered by the agency. So it kind of adds a protective layer there for the Medicaid recipient and for the caregiver themselves. So that pretty much wraps things up for that.

If you have any other questions or any other concerns regarding that, please feel free to get in touch with us. We’re at www.wellspringshomecare.com . I really appreciate you stopping by and I hope you found that informative and we’d love to hear from you. So have a great day and thanks for stopping by.