What are the "do's and don'ts" of home care under Medicaid?

Rjl asked...

What section do I find out the scope of practice for caregivers under Medicaid guidelines? I'm looking for the "do's and don'ts" of the home care aid.

Expert Answer

Merrily Orsini, MSSW, was a pioneer in the business of providing geriatric care managed in-home care. She currently serves on the board of the National Association for Home Care and Hospice and is Chair of the Private Duty Homecare Association. She holds a master's degree in social work and is a nationally known writer and speaker on aging, elder issues, and in-home care.

Unfortunately the question does not have a simple answer. If you are referring to the qualifications and competencies of personal care workers under Medicaid, federal law leaves most of that up to the individual states to determine. And the services provided are confusing, but relative to the scope of services considered as personal care, the states have some leeway depending on whether the services are in the Medicaid home health benefit, the personal care option benefit, the home and community-based services optional benefit, or a home and community-based services waiver program where the state designs who qualifies and what the beneficiaries get.

You can review regulatory standards at: http://www.access.gpo.gov/cgi-bin/cfrassemble.cgi?title=200842.

Look at sections 440.70 (Home Health); 440.167 (Personal Care services); 440.180 (Home and Community Based Services); and 440.181 (HCBS over 65).

Or, some guidance can be gleaned from the Medicaid PCA policy defining the personal care services optional benefit.