Upcoming Changes - November 2023

Covid-19 had a major impact on public health and the workforce. To streamline waiver services and ensure that older adults and individuals with disabilities received necessary care during this time, certain procedures were put into place through Medicaid waiver. These procedures allowed alternative delivery of services to address care needs during the public health emergency (PHE). The PHE ended on May 11, 2023, and many of the PHE flexibilities will end six months thereafter,  on November 11, 2023.

Let's start with the positives. Some services will remain permanent for our clients. 

• Transportation to Medical Appointments: Attendant care aides will still be allowed to provide clients with transportation to medical appointments, as long as the attendant care agency offers this.

• Parents as Paid Caregivers for Minor Children: The Medically Complex Warrior Program allows parents to be paid to care for children who have physical disabilities and/or skilled needs. While the Medically Complex Warrior Program was not a flexibility that was enacted during the PHE, this program will be made permanent past the end of the PHE. Spouses and parents of minors will be allowed to be reimbursed with waiver funds for their caregiving supports.

• Specialized Medical Equipment and Supplies Flexibilities: Interpreter services will be made permanent under the SMES service line in the waiver.

Now let's talk about some of the services that will be ending come November.

• Structured Family Care Flexibilities: During the PHE, individuals who received structured family care (SFC) services could also receive attendant care, home and community assistance, and transportation. As of November 11, participants receiving SFC will no longer be able to receive these additional services while receiving SFC.

• Adult Day Service Flexibilities: During the PHE, individuals who received adult day service (ADS) could also receive attendant care, home and community assistance, home delivered meals, and integrated health care coordination. ADS were also allowed to conduct virtual programming and programming in individuals’ homes. As of November 11, all of the above-described flexibilities are ending.

• Integrated Health Care Coordination Flexibilities: During the PHE all visits were allowed to be virtual to protect the health and safety of all individuals. After November 11, providers of integrated health care coordination must complete at least one face-to-face visit with each participant every month. Other visits may be virtual if the individual desires them to be. 

• Care Management Flexibilities: During the PHE, care managers were permitted to complete virtual visits with clients and to obtain verbal signatures on service plan update forms. As of November, virtual assessments are ending, and in-person/face-to-face assessments must occur at least once every 90 days as required under the waiver. Verbal signatures will no longer be allowed. All forms must be signed and dated at the time of the assessment/update. Electronic signatures will continue to be permitted.

• Nursing Facility Level of Care Flexibilities: During the PHE, clients who seemed to no longer meet nursing facility level of care (NFLOC) were allowed to continue to be approved for NFLOC and remain on their waiver. As of November 11, participants who seem to longer meet NFLOC will be reassessed at their next scheduled due date. If the participant no longer meets NFLOC upon re-assessment, the care manager will terminate the service plan.

It is important for case managers to discuss these changes with their clients. Clients who are receiving additional services to supplement SFC and ADS need to be made aware that these flexibilities are ending so that they can make other care arrangements. If you have any questions about these upcoming changes, please contact Golden Apple services at 260-602-6287. As always, we are here to help.