Medicaid Pays Some Families to Give Care
After suffering a stroke 18 months ago Bea Waters, 79, was thrilled to be able to return to her own home. Of course, she still needed help with getting in and out of her ancient tub safely. She couldn't do much housekeeping, and she had little strength to prepare meals. The promise of five hours of daily help from her state Medicaid program was what made the difference.
Soon after starting the Medicaid home care program, Bea and her daughter Jewel realized that the promise was much more than the reality. Their Medicaid agency was short staffed, so caregivers were unreliable. The uncertainty of not knowing whether help would arrive took an emotional and physical toll. When workers did show up, they were often new and, frankly, some were not too bright. Because Bea was not assertive about her needs, Jewel would have to run over to her mother's house to orient each new caregiver. A few excellent caregivers did occasionally arrive. They seldom lasted long before accepting a better-paying job.
Jewel began to think seriously about leaving her job to care for her mother. For a single person, this was not a good option, but the idea of a nursing home was even worse, and Bea could not afford the high cost of an assisted living residence.
Then Bea's Medicaid caseworker told her about a program that would allow her to select and pay for her own caregiver. Instead of forcing her to use the unreliable and costly services of an agency, she could receive the money to pay for care directly, and she could choose how and where to spend the money. She could even pay a friend or family member to provide the help she needed.
Bea and Jewel put their heads together. Although Jewel still couldn't afford to leave her job and benefits, her niece would be thrilled to give up her part-time job to care for Bea. The hours would be similar, and the working conditions would be much better. They all decided to give it a try, and while nothing is perfect, things have worked out well. Bea has reliable care from someone she trusts, and Jewel can go to work without feeling perpetually anxious.
It's the "Cash and Counseling" Program
What a strange name for a Medicaid caregiver program. The "Cash" part is self-explanatory: The recipient receives cash to pay for care. The "Counseling" is more ambiguous: Program participants receive regular counseling on how best to utilize their grants and help with paperwork and taxes.
The program has been around since 1996, when the Robert Wood Johnson Foundation helped fund a demonstrtion project in three states, Arkansas, Florida, and New Jersey. Those who chose to participate were assessed, and then received a monthly cash allowance based on their assessed needs. They were free to decide what services they wished to receive, and they were free to purchase services from either a licensed agency or private caregivers of their choice. They could even purchase services from family members and products that were not covered by Medicaid, such as home appliances, safety equipment or transportation.
Surveys of participants generally produced rave reviews.
Since 1996 the Cash and Counseling program has been expanded to 15 states: Alabama, Arkansas, Florida, Illinois, Iowa, Kentucky, Michigan, Minnesota, New Jersey, New Mexico, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia. Some (but not all) states that do not participate in the Cash and Counseling program have similar programs.
Cash and Counseling Program Elements
1. Medicaid Approval: The applicant must be approved for their state Medicaid community care program. Check with your local Medicaid office for information about the application process and documents;
2. Home Assessment: If the applicant is approved for community Medicaid, a state representative will visit the home and assess how much assistance is needed;
3. Benefit Determination: Based on the home assessment the applicant is awarded a specific number of hours of care assistance. Based on the cost of providing this help from an approved agency, the recipient is awarded a cash amount to pay for in-home care.
4. Counseling: A program counselor helps the recipient put together a care plan. The recipient must pay selected caregivers at least minimum wage, and the counselor will assist with employment paperwork and filing tax information. The counselor will also assist the recipient to decide what other purchases might also be helpful.
While the Cash and Counseling benefit may not be available in your state, getting the word out that it exists at all is the first step to getting it expanded. Since 1996 some elderly beneficiaries and their families have been receiving money to pay for care at home. Yet every day caregivers anguish that they can't afford to leave their jobs to provide care to an elderly loved one. States are spending Medicaid dollars to send seniors to nursing homes because their families can't afford to provide care themselves.
If your senior has a low income and few assets, the Cash and Counseling program is something to look into right away. If you don't live in one of the 15 states that currently participate, now is the time to contact your legislators. Let them know that the seniors in your state are just as deserving of a program that has been proven for 13 years, and that it won't cost a penny more than paying for nursing homes.