HOME CARE SERVICES;

OLR Research Report


1. Home care agencies where clients generally cannot choose who provides their care. But some states allow the home care agencies to hire the patient’s relatives or friends to provide the care under limited circumstances, such as when the family lives in a rural area and adequate care is not otherwise available, or when there are special medical conditions or hardships. Those that do, pay them through the agency, which is their employer, and require them to have the same training as a regular home health aide or personal care assistant hired through an agency.

2. Personal care attendant options where the PCA can be hired through a PCA agency or directly by the client who acts as the employer (the “consumer-directed option”). States most often allow this consumer-directed option under a Medicaid waiver or a state-funded program for limited numbers of people under special circumstances, for instance when the person lives in a rural area or cannot otherwise find appropriate help through an agency.

eight states require or allow a financial intermediary to issue the check directly to the employee and to handle deductions and payment of taxes on the clients’ behalf. (Connecticut also uses an intermediary acting for the consumer). Some states use different methods for different programs or let the clients choose which method they prefer.

Table 1: Continued

State

Payment to Family Members Allowed

Family Members Who Cannot Be Paid

How They Are Paid

Training Required

Illinois

Medicaid and state-funded: Y for disabled; Y for elderly (but no longer permit it as of 2/2002 for new elderly participants).

Spouses or legally liable relative, minor children, or foster parents or stepparents of minors

(Spouses can be paid in very limited circumstances for elderly. )

State pays caregiver in disabled consumer-directed option.

For elderly, must be employed by agency; no consumer-directed option for elderly

No for disabled consumer-directed option

Yes for elderly, same as other agency employees.

Indiana

Medicaid waiver: Y

(but consumer-directed not yet operational)

State-funded: Y

Spouses, parents of minor children

Medicaid waiver: not yet operational

State-funded: fiscal intermediary

N

Iowa

Medicaid: Y

Spouse, parent of minor child, or legally liable relative

Intermediary

 

Kansas

Medicaid: Y

State-funded: Y

Spouses and parents of a minor child

Intermediary (qualified provider serves as payroll agent)

N

Kentucky

Medicaid; N

State-funded: Y

Medicaid: No relatives.

State-funded: No limit

Intermediary

N

Louisiana

N

     

Maine

Medicaid Y

State-funded Y

Medicaid: Spouses, parents of minor children, legally liable relatives prohibited State-funded: No limit

Medicaid: Intermediary.

State-funded: state issues check to consumer

No if consumer-directed. If hired through agency must be trained or “judged competent”

Maryland

Medicaid: Y

State-funded: Y

Medicaid: Sps or legally liable guardians.

State-funded: Spouse, child, stepchild, parent, grandparent, sibling, or in-law, but other relatives allowed

Medicaid: Can be either agency-employed and paid by agency or consumer-employed and paid by fiscal intermediary.

State-funded: State reimburses consumer who initially pays PCA

No, but if agency-employed subject to same rules as other employees.

Massachusetts

Medicaid: Y

State-funded: Y

Spouses

Intermediary

N

Michigan

Medicaid: Y

Spouses and legally liable relatives

Intermediary

N

Minnesota

Medicaid: Y

State-funded: Y

Medicaid: Immediate family members, unless they get a hardship waiver;

State-funded: no limits

Medicaid: through provider agency.

State-funded: State pays client and client pays caregiver or hires an agent to act for him

N

Table 1: Continued

Table 1: Continued

Table 1: Continued

**Y=Yes