Maximizing Medicaid Waiver Support

Summary:

National Care Advisors was engaged by a bank trustee partner to assist a client who suffered a traumatic brain injury. The client had been awarded 50 hours per month of support services provided by In Home Support Services (Medicaid Waiver). After meeting with the client and his mother, assessing the client’s care needs, coordinating with current caregivers and advocating for an increase in support, the client was awarded the state maximum of 283 support hours per month. The value of these increased benefits is approximately $30,756 per year for this client.

Background:

A 16-year-old male suffered a traumatic brain injury from a motor vehicle accident at age 11. He was referred to National Care Advisors by his trustee to complete a special needs analysis. The accident left him with multiple disabilities, including issues with his vision, short term memory, voice production and articulation. He also sustained multiple compression fractures leaving him primarily wheelchair bound with right sided weakness. Additionally, the client was incontinent and required feeding through a gastrostomy tube. At the time of our assessment visit, the client was only receiving 50 hours per month of in-home supportive services (IHSS/Medicaid Waiver) through MediCal (Medicaid). His mother was paid to provide these services. It was the only income his Mother was receiving outside of her son’s monthly SSI award. The client also has two younger siblings that the mother cares for without significant support from their father. The mother is the client’s primary caregiver and was not aware that she could advocate for more hours. She was clearly feeling overwhelmed and was in tears for portions of our assessment visit.

National Care Advisors Involvement:

National Care Advisors worked closely with the Mother to help her document, quantify and report her current caregiving duties for her son, beyond normal expected parenting responsibility. Our nurse consultant coordinated with the client’s physician directly in obtaining the appropriate certification to verify the Client’s need for protective supervision and compiled the supporting medical records that would lend support for his need of additional supportive hours.

Outcome:

With NCA’s advocacy efforts in coordination with the client, trustee, medical providers and IHSS (Waiver) coordinator, the client was granted the maximum award of 283 IHSS hours/month. Our client and his mother are now receiving increased income and support through the use of third-party benefits and family caregivers can afford respite if they so choose. NCA continues to provide case management services to assist with this client’s Individualized Education Plan, equipment and therapy coordination, especially since he has recently moved to a new, trust-owned house.

NCA’s services have made a significant, measurable improvement to the expenditure plan to meet this client’s care needs. The real value of the additional 233 hours per month at $11/hr is approximately $2,563 per month or $30,756 annually. The value of the additional support to the mother serving as primary caregiver to her special needs child is immeasurable.