community nurse make a house call to seniorMost Certified Medicaid Planners™ generally applaud the trend of the last decade to move people from institutional care into home-based settings, but the results are mixed.

Medicaid covered home based care, known as Home and Community Based Services (HCBS) was originally only allowed through special, limited Medicaid waiver programs as Medicaid’s focus on long-term care had been principally focused on institutional care. The landmark Olmstead1 decision by the Supreme Court in 1999 set up a push nationally for programs to find the least-restrictive care setting possible, including using Medicaid dollars to move patients from nursing homes to assisted living or back home with home care.

In September of this year, a group of U.S. Senators pushed further for more home care in a letter to The Centers for Medicare & Medicaid Services (CMS). They encouraged CMS to loosen regulations in order to allow more people to receive care in the community rather than in nursing homes.

Besides the obvious personal dignity issues for the patient, the overriding factor for transitioning patients from the nursing home to HCBS is cost. Homecare, on average, costs much less than skilled nursing facility care. As states dealt with tightening budgets in the recent economic downturn, many have pushed to expand their HCBS rolls from their existing nursing home patient roster as a way to ease state Medicaid budgets.

People can go home where their more comfortable and states don’t have to pay as much – a win-win. So what could be the downside?

When the patient comes home, they often don’t do it in a vacuum. The state provides a certain level of care through home caregivers, but this care does not always align with the full needs of the patient – or a patient’s problems don’t always align with the schedule of provided caregivers. Spouses or family members often have to pick up the slack. What has been overlook is the heavy economic reliance upon friends and family which is often not considered when calculating the total costs of HCBS care.

This burden is not exclusively economic. Recent studies show that a large percentage of those caring for an elder have symptoms of depression, and a large percentage of those suffer from major depression – at rates far greater than society as a whole.

Medicaid is not completely deaf to these issues. Through the Medicaid “Cash and Counseling” program, family members can get paid to provide home care to Medicaid recipients in their own home. This can help family members who have to leave jobs or reduce their employment hours to help manage and care for a loved one.

However, the societal costs have even bigger impact. The economic value provided by family caregivers to frail elders has been estimated to range from $45 billion to $200 billion annually.2 It is estimated that the cost to U.S. businesses exceeds $25 billion a year in lost productivity.3

As the holidays approach, caregiver stress can be acute. AARP reports that caregiving stress coupled with holiday stress can lead to unhealthy behavior and feelings of helplessness. Anyone providing care during this time of year has to be aware of the extra burdens placed on them so as to avoid burnout or unhealthy consequences of being overstressed.

A Certified Medicaid Planner™ are trained and equipped to help people dealing with the care of a loved one determine whether home care is the best choice. There is a huge variance from state to state as to how home care programs are run – with much less continuity between the states than nursing home level of care. Often within a state, Medicaid’s home care rules differ dramatically from the Medicaid rules for nursing home level care – only adding an extra layer of stress to the family who need to understand not only the best care setting but also the best financial situation based on eligibility criteria. The help of a Certified Medicaid Planner™ can assist in giving you the peace of mind you need to navigate these complex programs effectively.

To find a Certified Medicaid Planner™ near you click here.


1 Olmstead v. L.C., 527 U.S. 581 (1999).

2Caregivers of Frail Elders: Updating a National Profile, Wolff and Kasper, The Gerontoligist, January 3 2006.

3Caregiving Costs U.S. Economy $25.2 Billion in Lost Productivity, Gallup, July 27, 2011.

410 Tips for Caregivers During the Holidays, AARP, December 6, 2103.

As the premier standard-setting body in the Medicaid Planning field, the CMP™ Governing Board established an ethics panel made up of professional Medicaid Planners.

CMP™ Governing Board
24600 Center Ridge Road, Ste. 270
Westlake, OH 44105
Phone: (844) 314-7851
Fax: (216) 220-1541

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