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A Proposal for Maximized Homecare
The goals of this proposal are to maximize self-direction and quality of homecare services for disabled people, while maintaining the fiscal concerns of the State. Also, the encouragement of fair competition in the caregiver field and eliminating conflict of interest situations are important goals of this proposal.
At a time of diminishing homecare resources and increasing costs, the State should not eliminate any cost effective homecare options. It's crucial the State continue contracting with self-employed caregivers while granting the recipients who choose that option, the same freedoms and supports proposed in other 1915J homecare models. Because the Independent Caregiver Model has greater potential for cost-saving as well significant participant benefits, it should be included in a test group demonstration.
We propose a test group of current waiver participants be allowed to model the 1915J Personal Assistance Services, (PAS)... before opening it up to the state plan. Let the participants choose between Medicaid's proposed ISO Managed Model, or the Division's Participant Employership Model or, the participant authored Independent Caregiver Model described below.
Independent Caregiver proposal points...
- The state allocates a monthly budget to the participant similarly as they would for the ISO agency managed model, less 15%. (Money is saved with the elimination of the middleman's overhead and profits. The savings benefit the State and the participant. The State pays out 15% less for the care but the participant enjoys an effectively greater allocation for needed services.)
- The participant controls the budget with the state caseworker monitoring.
- Reasonable parameters including disenrollment guidelines are established.
- Participants' caseworker advises of any budget issues that arise. (Informs on how it works, offers overspending warnings, initiates dis-enrollment when requested or imposed.)
- Within the allocated budget, participant determines starting wages and raises for his own personal care attendant. (Gives the participant the option to offer wage incentives that encourage longevity of services, further training, and better performance of services. It also allows the participant to maximize the use of this budget for his care as do other models.)
- Various wage rates can be set by the participant, within the limitations of his budget.
- The participant has control of all scheduling. (So as care needs fluctuate from day to day, the participant will have the option to use more or less care in the way that is most practical and appropriate for him.)
- Medicaid continues allowing state caseworker and participant/or rep. shared control of weekly authorization for each of their individual care providers.
- Any unspent allocation monies rollover to be used at the discretion of the participant for PAC services not otherwise covered or independence advancement items. (This will give the participant greater independence end eliminate some gaps in service. For example, accumulation could be used as a stipend to retain caregiver services during hospitalizations or temporary nursing facility stays. That would greatly alleviate re-transitioning problems).
- Any unspent hours of PAS are carried forward and used when needed, at the participants' discretion.
- The participant can elect to use any budget accumulation, not required for PAS, for items that might lessen his human dependence or increase personal independence. Any such cash disbursement is authorized by the caseworker directly to the vendor.
- The participant determines who he will hire or fire without interference from the Medicaid Division. (Other than CMS formal mandates or law, not Department determinations, the hiring/firing decision should rest solely with the participant.)
- All hiring and usage limitations are removed except as mandated by CMS or by law.
- The state continues to provide funding for all peripheral medical goods and supportive services necessary to sustain independent living.
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