As I described in my last post, the Aging Waiver program allows Medicaid-eligible patients who can be safely served in a home setting to receive in-home care on Medicaid’s dime; a dime which goes a lot farther in a home-based care setting than in a nursing home facility. The bad news is that the Aging Waiver program is being threatened by new regulations that make it financially impossible for many County Agencies on Aging to continue to provide waiver services.
In 2011, the PA General Assembly amended the Public Welfare Code when they passed Act 22. The amendments enabled the PA Department of Public Welfare (DPW) to use an expedited process for rulemaking when a regulation relates to Commonwealth grants or benefits like the Aging Waiver. In 2012, DPW used this new expedited rulemaking authority to make changes to provider payment rates and reimbursement models for the Aging Waiver. The changes are going into effect now, without any meaningful public comment period or regulatory oversight, and the effects may be devastating.
Prior to the new regulations, the Aging Waiver was managed by Area Agencies on Aging (AAAs) using a care management model. Under this model, the AAAs received state funding in a bundled amount to cover the cost of case management that would include in-home patient visits and RN oversight of care plans. The care management model was only performed by the AAAs, and included help with enrollment, selection of services, and a focus on matching consumers with appropriate caregivers in an ongoing way.
The new regulations changed the service model from one of care management to one of service coordination, which can be performed by AAAs and community providers. The service coordination model focuses more on consumer choice and responsibility, and less on holistic management of the patient’s care plan. Most damaging, the state no longer funds waiver services through bundled payments to the AAAs, which allows for more intensive case management. Instead, the state reimburses service coordination in 15-minute units of direct work with and on behalf of the patient/consumer. This makes frequent home visits and check-ins impractical and expensive. Service coordinators are now only required to make one phone call or home visit per quarter. The case worker has essentially been transformed into a schedule coordinator; the state isn’t paying the AAAs to care about the consumer’s need, but to sign them up for services and check in every three months.
Many AAAs have been forced to lay off case workers due to the rate changes, and other AAAs have found they cannot afford to continue to administer the Aging Waiver program. As a result, in-home care has become unavailable to people who could benefit from it. The options for Medicaid-eligible seniors have been narrowed to nursing home care, or no care at all. If you would like more information on this issue, see the C.A.R.I.E. website or call your local legislator.