#1 Health and Wellness waiver
Members are 59 and younger
Health and Wellness waiver allows individuals who are aged, blind, or disabled to remain in their home as an alternative to a nursing facility placement. Health and Wellness is also transitioning to the Division of Disability and Rehabilitative Services.
#2 Pathways of aging waiver
Members are 60 and over
Members are enrolled in a health plan. The managed care entities (health plans) are United Health Care, Humana, and Anthem.
Has the old A&D waiver split into two waivers? Yes
Who cannot provide care under the Attendant Care Program?
Biological or adoptive parent who is a legally responsible individual, legal guardian of a minor child, foster parent or a spouse who is a legally responsible individual.
Who cannot provide care under the Structured Family Care Program?
Anybody can perform care.
What happens if you do not have Medicaid?
We will work with you and Medicaid to see if you qualify. Just because you may not have Medicaid does not mean you do not qualify.
Who is determining the Level of Care for clients?
Care managers complete the SFC tier assessment to determine the SFC level based on the individual’s assessed needs. The SFC Level of Service assessment is completed at the initial annual, any re-entries, or if it’s believed Level of Service has changed.
Under what regulations will the RN be able to assess, administer medications, provide wound care, etc.
The RN for SFC is in place on an as-needed consultative basis depending on the needs of the individual and principal caregiver. The RN is not delivering hands on care but is serving in an oversight capacity to support the principal caregiver in conjunction with the support offered the caregiver coach. RNs are in a supporting capacity to enhance the caregiver coach on the more medical aspects of caring for the person receiving services. The need for skilled care or intervention would fall to home health services or delivered separate from the SFC service.
Can Family Members/LRIs provide Medication Administration if they are the paid structured family caregiver?
The administration of medication by immediate family members would be allowable as part of the typical role and responsibility of an immediate family member. Given that SFC pays a per diem rate the medication administration would not be part of the activities and support provided by a family members paid as a structured family caregiver, but rather an activity that typically occurs between the member and immediate family. Because medication administration is not a Structured Family Caregiving service, it should not be included in documentation of Structured Family Caregiving services.
Is respite included in SFC?
Yes, up to fifteen days of unskilled care per calendar year. Respite is considered temporary relief to caregivers to provide opportunities for caregivers to take a break while or ensuring the member’s needs continue to be met during the relief period.
If I am the paid principal caregiver for a waiver recipient receiving Structured Family Caregiving, can another member of our household be a Home Health Aide for them, assuming they are qualified to do so?
Yes, Structured Family Caregiving and PA for Home Health services can both be authorized if they are not provided by the same individual and not provided at the same moment in time.
What happens if a Caregiver becomes ill under the Structured Family Care Program, and cannot take care of their loved one?
Your backup Caregiver will provide services for that day and receive compensation.
What is the difference in compensation for the Caregiver providing services under the Structured Family Care and Attendant Care Program?
The Caregiver gets paid an hourly rate under the Attendant Care Program with tax deductions. Under the Structured Family Care Program, the Caregiver receives a non-taxable daily rate.
Can a Caregiver work a regular job?
Yes, as long as the patient is being taken care of.
