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Medicaid Beneficiaries Who Need Home and Community-Based Services: Supporting Independent Living and Community Integration

Patricia, Age 57, Logansport, Louisiana

Medicaid home health aide services would ensure that woman with multiple chronic conditions can remain safely at home.

Patricia lives alone in a two bedroom house. She is very hard of hearing and has advanced chronic obstructive pulmonary disease, type II diabetes, high blood pressure, a left rotator cuff injury, and dizziness. She uses oxygen 24 hours a day and takes multiple medications. Patricia has had problems with retaining fluid and recently experienced facial numbness and a skin problem that required medication. She uses a wheelchair and worries about falling. When she has fallen in the past, someone has had difficulty helping her to get up.

“I don’t understand why Medicaid will pay for nursing facility care when it would be cheaper to have care in my home.”
-Patricia, age 57

Patricia presently receives a home nurse visit every two weeks to check her vital signs. Her ex-husband helps her with yard work and home repairs, but she still needs help with cleaning, changing her sheets, cooking, and showering. Patricia cannot stand for long periods of time and says that cooking, sweeping, or mopping “takes a lot out of [her].” When Patricia is alone, she eats sandwiches or microwaved meals. She also needs transportation to get to doctor appointments and the grocery store because she is physically unable to drive. One of her doctor’s offices is over an hour away, and she must pay someone to drive her there. She also would like companionship because she is mostly by herself and has no one with whom she can talk.

Patricia receives Social Security benefits, food stamps, Medicare, and Medicaid only to help with her Medicare out-of-pocket costs. Patricia has paid out-of-pocket for home health aide services in the past, but she only can afford to pay $90 for 12 hours of help per week, which people tell her is not enough money, and she has difficulty finding people who can reliably help her. She has to find friends or friends of friends through word of mouth to help her, and they are not trained. She would prefer to have services from someone who is properly trained and would know what to do if she fell.

Patricia’s initial application for Medicaid home and community-based waiver services was denied because she was told that she did not qualify for a nursing home level of care. However, she had difficulty hearing what was said because the assessment was done by phone. She thinks that the assessment should have been done in person in her home. She appealed the denial but also had difficulty understanding what was said during the telephone hearing. Finally, she called an advocate for help, and since July 2013, she has been on the waiver waiting list. At that time, she was told that there is a three year wait for services, and she has not had any subsequent updates about her status. Patricia was told that she could receive HCBS if she first went into a nursing facility, but she does not think that would make sense financially. She also fears that, if she were to go into a nursing facility, she would “never come home again.”

Ideally, Patricia would like to have home health aide services for four to six hours per day, three to four days per week. She says that she sometimes is concerned about her ability to continue to live at home and having Medicaid home and community-based waiver services would change her life “greatly” and would “make a big difference to [her].”

Mary A., Age 79, Winston-Salem, North Carolina Mary B., Age 72, Kernersville, North Carolina