Medicaid

Will Medicaid Pay for In-Home Care?

Good day everyone and welcome to the Wellsprings Home Care Podcast. I’ll be your host, Justin Currie. I am the owner and also a certified Senior Care Manager here at Wellsprings Home Care and Wellsprings main office is located in Exton, Pennsylvania. We serve the counties of Montgomery, Delaware, and Chester.  

What wellsprings does is provides non-medical home care services to seniors predominantly, but also those with disabilities. And one thing we wanted to point out today is that we’re really proud to announce that SeniorAdvisor.com has actually named Wellsprings one a 2020’s Best of Home Care awards. And what that is, is it’s actually given out to the top 2 to 3% of home care providers nationwide. So obviously that’s an honor for us to get that award and we’re super excited about it and we’re really proud of our team over here at Wellsprings and we can’t wait start working on 2021 and hopefully take the award home again. 

On today’s topic is, Will Medicaid pay for In-Home Care? So that’s a question a lot of you have, there’s a lot of gray area with Medicaid. It’s a government program.  

So first of all we’ll jump into what is Medicaid. Medicaid essentially it provides health coverage to Americans. And typically what this is, is it’s low income individuals and those that basically they can’t always pay for Medicare premiums and things like that. That’s where Medicaid comes into play in. It’s for essentially any adult, pregnant women, those with disabilities, children, anybody who needs assistance at home and does not have the financial backing to pay for that themselves. Medicaid is funded by both the state and the federal government so they work in partnership to fund that program. 

So in short, will Medicaid pay for in home care services? And the short answer is yes, they’ll pay for non-medical home care services, but they’ll also pay for home health care, homemaker services, family and caregiver support, home and environmental accessibility modifications, medical equipment, nutrition, transportation. There’s a lot of different things that they can pay for depending on the waiver that you’ve applied for. And Medicaid pays for home care services because generally most people want to stay at home and obviously, that’s where they’re more comfortable. That’s where they want to be taken care of. And also because not everyone can go into a facility, there’s obviously only so much space in the facilities and people want to stay at home and it’s actually cheaper for them and for the individuals themselves and for the government for in home care. 

So those are a few of the reasons is why Medicaid funds this and some of the waivers in Pennsylvania, there’s a lot of different ones, so it really depends on your own unique situation. But there is a lot of assistance out there, Wellsprings Home Care can provide assistance with Medicaid waivers. You can just get in contact with us I’ll leave our information at the end of the podcast here, but some of the waivers that you can apply for in Pennsylvania are, there’s a community living waiver, aging waiver attendant care waiver, independence waiver, adult community autism program, adult autism waiver, infants, toddlers and families waiver person, family directed support waiver, consolidated waiver, the Obra waiver and also the life waiver, which is living independence for the elderly program. So those are some of the waivers that you can apply for in PA. 

So obviously it’s adaptable to different situations and people’s own personal situations. So there’s usually an option on there. If you are a low income individual, then there’s a lot of different options that might be able to help you out with funding. 

Wellsprings home care services is an approved provider for Medicaid in Pennsylvania and we are approved by all three MCOs, which are Managed Care Organizations. So when you do get approved for a waiver, you’re going to have to choose a managed care organization who are essentially just all billing and claims and everything like that go through. There’s not a huge difference between the three MCOs but the three MCOs are Keystone First, UPMC and PA Health and Wellness, and Wellsprings is a provider for all three MCOs. So no matter which waiver you’re on, you can contact us and we should be able to help you out or at the very least point you in the right direction. 

There’s different steps for obviously if you’re approved already by Medicaid or if you’re in the approval process. Some of the steps for someone who would already be approved would be to get in contact with Wellsprings and we can help guide you through the process or if you want, you can talk directly to your service coordinator and your service coordinator, well they’ll be in charge of allocating your hours and then also signing you up with a witch provider you choose to use. So if you choose to use Wellsprings, Homecare, Wellsprings as well as your service coordinator as well as yourself, we’ll all be in communication and we’ll allocate a certain amount of hours to your care. And that’s when Wellsprings will step in and screen and obviously, try and match you with one of our caregivers and hopefully start out service that way. 

And the steps are obviously a little more extensive for those who have not yet been approved yet. It is an insurance program, so it can be a lengthy approval process depending on the individual situation. But the four different ways that you can apply is online. So you can actually go to the compass website, that’s just Compass in PA and you can apply online.  

You can apply by telephone by calling 1-866–550–4355 or you can go in person down to one of the County assistance offices. Those are CAOs. And if you search those online, that’ll tell you kind of which one is nearest to you.  

And the last would be on paper, but with on paper you would have to go to the department of human services website and they’ll actually have a form for you to fill out. 

You can do a search for application for Medicaid waivers. I wouldn’t recommend on paper unless you have a really strong background with just with general knowledge of both the waivers. You definitely want somebody helping you out with that.  

So that’s when you can get in touch with us and we can kind of guide you through the process and point you in the right direction. 

So in summary for Will Medicaid pay for In-Home Care? The answer is yes. There are several different waiver options that you can apply for and obviously everyone has different requirements and different regulations that you have to meet in order to be approved for the waiver but they are all listed on the department of human services website and you can go there anytime or you can call us and we can definitely provide you the information. 

And if you want to call us, you can call 610-463-0880  or you can go ahead and email us at info@wellspringshomecare.com . 

So that’s all I have for you today. I hope that provides a little bit more information on Medicaid and if they will pay for home care services and also kind of how to go about obtaining the services or the approval depending on your situation. So thanks a lot for stopping by and as always, get in touch with us if you have any questions or concerns and we look forward to seeing you next time. Thank you. 

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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 Chttps://wellspringshomecare.com/home-care-services/dementia-careare 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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Does Medicaid Pay for Family Caregivers?

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.

  1. 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.

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