Home Care in the United States - Home and Community Based Medicaid Services - Essay Example

To address home health care needs and decrease the state’s expenditures with regard to institutional care, Ohio has applied for a number of waivers under Section 1915 (c) of the Social Security Act through its Home Care Waiver Services, PASSPORT Waiver, Transition Waiver, Individual Options Waiver, and Level One Waiver; administrated through the coordinated efforts of the Ohio Department of Job and Family Services (ODJFS), the Ohio Department of Mental Retardation and Developmental Disabilities (ODMRDD), and the Ohio Department of Aging (Ohio Legal Rights Service [OLRS] 2005, ‘Medicaid Waiver Programs in Ohio’). Together, these programs served the elderly 30,936 patients in 2005 (National State Medicaid Directors Association [NSMDA] 2005, ‘Medicaid Home and Community Based Service Waivers – 1915 [c]’, p.3).

          In order to be eligible for home care under these waivers, the state required that all applicants must first pass the pre-admission review, conducted by the Ohio Department of Aging Pre-Admission Review, instituted in 1993 (Applebaum, R, Mehdizadeh, S & Straker, JK 2000, ‘Ohio’s Long-Term Care System: Trends and Issues’, Scripps Gerontology Center, Miami University, p. 11). However, while the elderly can attain home care services through all aforementioned waivers, the program specifically designed for them is the PASSPORT waiver.

          To be eligible for the PASSPORT Waiver, applicants must meet a specific financial criterion. In addition, they must also require an intermediate level of care, and must be at least 60 years old. It is important to note that the only difference, with regard to the eligibility requirements of other waivers, is the age requirement, which only applies to the PASSPORT Waiver.

          Specifically, aside from the pre-admission review, they must first be eligible for Medicaid institutional care. To be eligible, they must be earning no more than $1,737 per month for one person and having no more than $1,500 in countable assets. However, individuals that are earning more than the mentioned amount may still be eligible if they are: (a) widows or widowers entitled to a monthly social security benefit, were made ineligible for SSI because of an increase in their widow or widower’s benefits which resulted from the social security amendment, or filed for a Medicaid application to reinstate their ineligibility; or (b) individuals with a disability (Ohio Department of Job and Family Services [ODJFS] 2002, ‘Medicaid Eligibility Manual’, Chapter 3.1). Second, they must be frail enough to require a nursing home level of care (ILOC). And last, they must be able to stay safely at home, with consent from their physician. Others may also be made eligible by means of a “spend down”, meaning that “they have incurred or paid a specific amount of medical bills” (ODJFS 2005, ‘Ohio Medicaid Fact Sheet’, p.2).

Kentucky’s Medicaid: Access to Home Care for the Elderly

           The basic policy of the Kentucky Medicaid Program is to ensure the availability and accessibility of quality medical care to eligible recipients. In order to achieve this, the state requested a waiver under Section 1915 (c) of the Social Security Act to institute Adult Day Health Care (ADHC) administrated by Kentucky’s Department of Medicaid Services (DMS) to provide home and community-based services for the aging and disabled members of the population who would otherwise require a nursing facility (Department for Medicaid Services [DMS] 2003, ‘Department for Medicaid Services Adult Day Health Care Services Manual’, p. 3.1). Through this program, the state’s Medicaid has already served 15, 629 patients in 2005 (NSMDA 2005, p.2).

          Specifically, individuals eligible for the program are those who belong to the mandatory categorically needy and optional categorically needy nursing facility level requirement, which includes the aged, blind, and disabled individuals (DMS 2003, p. 3.2). In addition, the person must also meet the financial eligibility requirements, which for Kentucky refers to those eligible to receive a $217 SSI.

          In addition to the general requirements mentioned in the previous passage, individuals must also undergo a four-stage process to determine eligibility. First, the individual part of the aforementioned eligible groups must pass the Medicaid Process of Eligibility, where the applicant for a waiver must apply for. The individual will then be assessed based on his income, resources, life insurance, and medical bills, as well as his spouse or other responsible party’s combined countable resources (DMS 2003, p. 3.2). However, while an applicant’s spouse or other responsible party’s resources are included in the calculation, the income requirement is only considered for the applicant, alone. In this regard, he must have an income that is less than or equal to 300 percent of the state’s SSI standard, which is at $217.

Second, the applicant must present his Continuing Income Liability, which will be the amount paid to the ADHC provider by the recipient of the service. Third, the applicant must also pass the Waiver Eligibility Determination were to be eligible; he must meet the level of care criteria for nursing facility services. As mentioned, the applicant must be mandatory categorically or optional categorically needy, to be determined by the applicant’s attending physician (DMS 2003, p. 3.6). Lastly, the individual applying for the waiver must meet the ADHC Eligibility, which requires the applicant to present his physician’s recommendation regarding the level of nursing facility care needed, to be confirmed by the Peer Review Organization (PRO) (DMS 2003, p. 3.8).