You may have seen recent articles on the newest Medicaid program to be introduced to our area, “The Long Term Care Diversion Program” and may be wondering if it is an option for your loved one or client. Aging Wisely can help you to identify this and other benefit programs that would be appropriate. Here are some basics on this new program:
- Must be 65 years or older and have Medicare A & B.
- Financial qualifications (income and asset test) are the same as ICP (Nursing Home) Medicaid.
- Client must meet the level of care as determined by a CARES evaluation. In order to be eligible, the client must require a certain level of assistance and be determined by CARES to be someone who can be safely served with community based services in lieu of nursing home placement. Level of assistance requirements: individual must require assistance with 5 ADLs (Activities of Daily Living, e.g. bathing, dressing) or need assistance with 4 ADLs and require medication management or have a diagnosis of dementia and require supervision/assistance with 3 ADLs.
- The client/family chooses a provider, who manages care and provides services to the client, ranging from in-home services to assisted living. The goal of the program is to maintain maximum independence and hopefully “divert” people from nursing home care where it may be unnecessary. This is a “managed care” program, in which providers are paid a fixed rate per client per month and they determine which services are needed by each client.
- This program is not intended to provide 24-hour care in the home. The provider assigns a case manager who evaluates and coordinates services. Home-based services may include: home health aides, home delivered meals, emergency response systems, and consumable medical supplies. Prescription drugs are covered.
Frequently Asked Questions
How can Aging Wisely help me if I think this program might be right for my loved one?
We can help you to understand all your choices to make the most appropriate decision for your loved one, as well as explain all the “ins and outs” and the process you will need to go through to become eligible. We can link you with elder law attorneys and other professionals as needed to assist you in qualifying for public benefits.
How much help is available in the home through this program?
The case manager from your provider determines what services are needed. Typical services for in-home clients include a home health aide visit three times per week, an emergency response system and as needed, home delivered meals, supplies and equipment. Aging Wisely can help you to pre-determine if this program would provide appropriate services for your situation (e.g. is not appropriate for someone who is unsafe at home without 24-hour supervision/assistance) before you move forward with the process. Aging Wisely can help you determine what additional services may be necessary to help you remain at home.
How do I know which provider to choose?
Because this program allows you to choose the provider, it is important that you are comfortable with the provider and the choices available through them. Each provider may have contracts with different entities (e.g. different assisted living facilities) and this may play into your choice. Aging Wisely is glad to advise you on analyzing these options.
Providers are paid a fixed rate per client per month, from which they must pay for all services they deem necessary. As with other managed care programs, the provider is managing and making decisions about services needed which may limit client control.
Will I still need an Aging Wisely care manager once I’m on this program?
Many families will still choose to engage the services of a private care manager on an ongoing basis. Although the case manager provided through the program will assist in coordinating services, many families wish to have a private care manager available for such things as doctor’s visits, continued advocacy, and additional monitoring. The case manager provided through the program is required to visit each client only twice per year. Aging Wisely care managers only carry a caseload of approximately 10 clients and will visit as often as the responsible person feels it necessary. Many families, particularly those living at a distance, find this personalized attention necessary for their peace of mind.
As with any newer program, and particularly as programs in the state of FL move toward a “managed care” model, it is essential to be an informed consumer. In many cases, that is best accomplished with an advocate on your side to provide guidance. We don’t have all the easy answers, but we help you to find the best solutions.
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