What Programs Are Available To Assist People With Disabilities in New Hampshire? Is there a Medicaid waiver program in New Hampshire? New Hampshire has several. About Medicaid Home & Community-Based Services. State Waivers List; Program Information. Medicaid and CHIP. These programs serve a variety of targeted.

• Texas Medicaid Waiver Programs

. Table of Contents. Overview of Cash and Counseling Definition Cash & Counseling Programs are financial and care assistance programs, usually but not always from Medicaid, which provide the beneficiary with cash assistance and with the flexibility to 'consumer direct' or self-direct the spending of the cash on care providers of their choosing. Most states have their own names for their Cash and Counseling Programs, typically associated with a specific Medicaid waiver. For example, in Arkansas, their program is called “IndependentChoices”, in California, “In Home Supportive Services” and in Michigan, the “Choice Waiver”. Under Cash & Counseling / Consumer Directed Care programs, family members, including the adult children and sometimes spouses, can be hired as caregivers.

History and Recent Changes The Cash & Counseling Program began as a pilot Medicaid program in fifteen states with the objective of increasing participants’ control over their care services and providers. Traditionally, Medicaid would contract with home care agencies to provide personal assistance services such as help with bathing, dressing, grooming and cooking. Under Cash & Counseling, care recipients were given the flexibility to choose their own home care agencies.

Family members could act as a “home care agency”. This meant that relatives, such as the adult children of aging parents, could be hired and paid for the personal assistance they provided. Family members could become paid caregivers.

Since the original pilot program, both the concept of Cash and Counseling and the number of states in which it is available has expanded considerably. In addition, the name 'Cash and Counseling' is dated. This concept is now referred to as Consumer Direction, Participant Direction, Self-Directed Care and a variety of other state-specific names. The organization tasked with the administration of the original Cash and Counseling program is now referred to as the National Resource Center for Participant-Directed Services (NRCPDS). There are four different types of Cash and Counseling / Consumer Direction care programs and these are available in forty-nine states.

Texas Medicaid Waiver Programs

The concept of consumer direction in care, which allows family members to be paid, now extends well beyond Medicaid. There are non-Medicaid programs, veterans’ programs and programs for life insurance and long term care insurance policyholders, all of which allow for family members to be paid caregivers. Currently forty-five states offer consumer direction in their Medicaid programs, twenty-three states have consumer direction in non-Medicaid or non-profit assistance programs, thirty-four states allow for some veterans’ care services to be self-directed and life and long term care insurance policy conversion programs are available in all 50 states. Timer tools free download.

How Cash and Counseling Programs Work Most people are introduced to Cash and Counseling programs when asking the question: Can I get paid to be a caregiver? While many of these programs allow family caregivers to be paid, they also offer an even greater benefit; the choice of care providers. Most Cash and Counseling programs, or in more contemporary language Consumer Directed Care programs, are based on Medicaid HCBS Waivers. Presuming the individual in need of care is already Medicaid-eligible, these programs typically work as follows. The process begins with an assessment to determine the senior’s care needs; this includes interviews with caregivers and the senior’s physicians.

A determination is made regarding how many monthly care hours are required. A benefit amount or budget is calculated using the number of care hours and cost of care for that specific geographic area. This budget can be increased or decreased as the senior’s needs change. Program participants are considered to be “employers” and they decide how to allocate the budget they are given. They can hire family members as “employees”, including their adult children and. Most programs have a provision that allows surrogate decision makers to help the individual in need of care with the selection of care providers and the management of funds.

To avoid conflicts of interest, the surrogate decision maker and the individual being paid for caregiving cannot be one in the same. Some state programs require that financial management companies be used to make sure applicable payroll taxes are filed (remember the senior is considered “an employer”). In other states, the role of the middleman that manages the finances is greatly expanded. Not only do they manage the distribution of the funds between the state and the caregiver employees, but they track hours, provide training, offer backup caregivers and manage the administrative details with the Medicaid program. This expanded service comes at a price as the middlemen take a percentage of the amount that would otherwise be paid to the family. Originally, the Cash and Counseling program was designed specifically for in-home care. Today some states have expanded their programs to include individuals that reside in small group homes and even assisted living residences.

Other states allow relatives to serve as adult foster care providers. In this situation, the elderly individual moves into the home of their caregiver. Caregivers receive compensation for providing care and may receive an additional stipend for room and board (though, to be clear, not from Medicaid). Nursing home residents are not eligible to participate in Cash and Counseling programs. Eligibility Requirements Each program that offers Cash and Counseling / Consumer Directed Care has its own eligibility requirements. Medicaid programs have a functional requirement (the participant must require a certain level of care).

Persons that require skilled nursing, have severe mental impairments such as Alzheimer's or require assistance to perform several activities of daily living such as dressing, bathing, toileting and eating will most likely be medically eligibility. Financially, one must be Medicaid eligible in their state. Typically, persons with annual income under $25,000 and assets valued at less than $2,000 (excluding the home) are eligible.

Having said that, many states have higher limits and there is considerable flexibility in what is considered to be 'countable income' and 'countable assets'. For example, a home, vehicle and a prepaid funeral plan are considered to be non-countable assets. Furthermore, in some states there is no fixed income limit but rather a determination is made if the applicant can afford their own cost of care.

Complicating Medicaid eligibility still further is the fact that couples can apply together, or one spouse can apply and the other can chose not to apply. This mixed-spouse status dramatically raises the income and asset limits for Medicaid. It is recommended that couples in this situation or persons unsure of their Medicaid eligibility status prior to completing a Medicaid application. A state by state list of Medicaid programs can be found. Non-Medicaid programs that operate on the consumer directed care model have less rigid financial requirements than Medicaid programs. However, like Medicaid, there are functional ability and financial criteria. These programs and their eligibility criteria can be found by exploring the program links.

Persons who have life insurance policies and wish to pay family members for their care have eligibility requirements related both to their policies and their personal health. Those with long term care insurance, can. Veterans can participate in. Alternatively, veterans’ pensions, such as the benefit, can also be structured to pay related caregivers, though not spouses. Did You Know? There are many non-Medicaid and other options that pay the adult children to care for their aging parents. Benefits Benefit Details Benefits from Cash & Counseling programs vary by state and program type.

In general, the benefits to a participant are increased control and flexibility with regards to how their care dollars are spent. Participants are granted a budget instead of being provided with care services and they are granted a certain amount of control over how the budget is spent. Some programs provide participants with cash directly and others make use of a financial management company or “fiscal intermediary” that handles payments to care providers and other services on the participant’s behalf. Typically, when an individual joins a Cash and Counseling program, certain restrictions or limitations are set with regards to how their care budget can be spent. Within those guidelines, participants are free to determine what goods and which service providers they prefer. Many programs allow participants to hire family members to provide them with personal care. The money can also be used to purchase items related to their activities of daily living; a cleaning service, meal preparation, laundry service, medical alert service and transportation for medical appointments are also acceptable services.

Monthly allowances are determined by need and with consideration to the average cost of care for a specific geographic area. In addition, most states cap the maximum monthly allowance to not exceed what the cost would be if the state were to provide the care services. In the original Cash and Counseling pilot program, monthly state caps ranged from approximately $500 to $4,000. However, today given the diversity and broad range of Cash and Counseling model programs, it is impossible to say what the maximum limits are. Getting Paid as a Caregiver Undoubtedly the most attractive component of Cash and Counseling programs is the fact that family members and friends can be paid as caregivers of the program participant. How this works is the program participant (the individual in need of assistance) hires their family member or friend as their personal care provider. Sometimes it is just that easy and other times fiscal intermediaries are required, payroll taxes are due and the family member has to register with their state as a licensed care provider and be subjected to a background check.

Each state and program has different policies. In 2017, thirty-eight states excluded spouses from being hired as caregivers, but. Most programs do not exclude the adult children, in-laws or grandchildren.

In addition, ex-spouses are typically not excluded leading to a rather absurd situation where couples get divorced in order to care for one another. Payment rates to the care providers are determined by the program rules or by the fiscal intermediaries. Typically, care providers are paid an hourly rate several dollars per hour less than the. For more information, please follows the links to the specific programs below.

Did You Know? In recent years, some states, veterans' programs and insurance policies have been modified to allow spouses to be paid as caregivers. Application Process What to Expect Depending on one’s state of residence and the specific Cash and Counseling program for which they are interested, the enrollment process varies. If the care recipient is currently receiving Medicaid benefits, families should expect 2-4 months of processing time prior to receiving payments for caregiving. Should the care recipient not be receiving Medicaid benefits, one should estimate an additional 45-90 days for Medicaid enrollment to process. Having said that, it is important to remember that most Cash and Counseling programs are under Medicaid Waivers. Medicaid Waivers, unlike institutional or nursing home Medicaid, are not entitlements.

These waivers have limited enrollment and waiting lists are not unusual. Time spent on a waiting list is not included in the averages mentioned above. How to Apply One typically completes a Medicaid application with the state or county Medicaid office.

It is very common to seek the expertise of a in advance to application to improve one's chances of being accepted. Once accepted by Medicaid, one can then apply for the specific Medicaid Waiver that allows for Cash and Counseling or Consumer Direction. A complete list of programs is below. There are no costs associated with a Medicaid or Medicaid waiver application.

Enrollment in Medicaid does not require monthly payments. There may be co-pay amounts but these are very minor.

For persons wishing to use a life insurance policy to pay for family members for care, the. List of Programs Depending on one’s state of residence and the specific Cash and Counseling program for which they are interested, the enrollment process varies. Choose any of the links below to read more about a specific Cash and Counseling program or program that allows for Consumer Direction. Did You Know?

Under the Family and Medical Leave Act, you can care for your loved one without losing your job or health insurance. Cash and Counseling Programs for Veterans Consumer Direction with Insurance Non-Medicaid Programs with Consumer Direction (Note some programs may be listed twice as they are open to both Medicaid and non-Medicaid participants.) Medicaid Programs with Consumer Direction (limited) States Allowing Relatives as Foster Care Providers (Note this list may not be exhaustive) Connecticut Louisiana Indiana Massachusetts Ohio Oregon Rhode Island Texas.

. About NH Medicaid NH Medicaid is a federal and state funded health care program that serves a wide range of needy individuals and families who meet certain eligibility requirements. The program works to ensure that eligible adults and children have access to needed health care services by enrolling and paying providers to deliver covered services to eligible recipients. Covered Medical Services Medicaid provides payment for health care services ranging from routine preventive medical care for children to institutional care for the elderly and disabled.