How much say do you have in choosing a Medicaid home care provider?

A fellow caregiver asked...

If an applicant is eligible for Medicaid financial assistance for Home Care, how much latitude does the individual, and family, have in choosing a Medicaid home care provider?

In other words, is the monthly stipend simply a certain amount--without stipulation as to whom we need to hire?

Expert Answer

Home care covered by Medicaid is usually provided only by a Medicaid-certified home health care agency. The amount of and type of care provided, and paid for by Medicaid, is based on the Medicaid beneficiary's need -- there is no pre-set amount of home care. The amount of care for a particular beneficiary is determined by the home care agency, in consultation with the beneficiary's doctor. This determination of needs is set out in a plan of care developed by the home care agency and is reviewed by the state Medicaid program. The beneficiary can choose among local Medicaid-certified home health care agencies. If the beneficiary is not satisfied with the home care agency that delivers the care, the beneficiary can request a different Medicaid-certified agency.

In some states, however, it may be possible to have the Medicaid program pay the beneficiary directly for home care. The beneficiary can then turn around and pay a family member, or anyone else, to provide that care. This special program is often called Cash and Counseling (though in some states it may have another name), and pays a Medicaid beneficiary directly to cover their in-home care. The amount the beneficiary receives depends on a Medicaid assessment of need and the prevailing pay rate for in-home care aides in that state.

Cash and Counseling programs are currently in effect in the following states: Alabama, Arkansas, Florida, Illinois, Iowa, Kentucky, Michigan, Minnesota, New Jersey, New Mexico, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia. But other states have programs similar to Cash and Counseling. To find out more about these programs, and to see if there's such a program in the state where you live, see the article on this site How to Get Paid for Being a Family Caregiver.