What is a Florida Medicaid Waiver? With Amy O'Rourke of O'Rourke and Associates in Orlando.
Attorney Tom Olsen: -think about Medicaid, they think about going into a nursing home. What you're saying is that there are some people out there that they're not ready for a nursing home, but they need some help in-home and Medicaid has a service available to people for that.
Amy O'Rouke: That's right and most people want to stay at home.
Attorney Tom Olsen: I would think so. Yes.
Amy: We want people to stay at home. What we're good at is helping people access Medicaid benefits to help get free care. Then if there's any other access to your finances, or children, or whatever, to help you stay at home for as long as you want to stay at home.
Attorney Tom Olsen: I want to call this a Medicaid waiver. Is that the right term for it?
Amy: It is the right term. Yes.
Attorney Tom Olsen: Medicaid waiver, folks. If you got an elderly parent not ready for a nursing home, but needs some help at home, we have something called a Medicaid waiver. If you're in that situation, whether it's-- First of all, would a typically elderly person, would they be the one to apply for this Medicaid waiver themselves, or would one of the kids do it on behalf of mom and dad?
Amy: I would want the children to do it on behalf of mom and dad because it gets a little overwhelming. We would help the children get mom and dad on the waiting list. I love to think about a gentleman that I took care of, William, at home on this Medicaid program for six years. It worked beautifully for him. He didn't want to go into assisted living. That Medicaid waiver program would've also helped pay for the care in assisted living but his preference was to stay at home. He did that until one week he was in the hospital and died.
Tom: Let me ask you. We know normally to qualify for Medicaid, you have to spin down or get some nursing home Medicaid planning through Robert Hidock at our office but is this also financial qualified to get this service?
Amy: There are financial qualifications that you have to meet. We teach with Robert those eligibility requirements, and help you know if you're ready for it or not.
Tom: People are living at home, they want to have, you said 5 to 30 hours of assistance every week at home. That's what people want. They want to stay at home. You, Amy O'Rouke and O'Rouke & Associates can help people to qualify for that and it has to do with two things. Number one, getting them financially qualified, and that’s what Robert Hidock at our office can help them with.
Amy: Correct.
Tom: Then number two, you're helping them work the system to get them qualified for in-home care through a Medicaid waiver program. I think what you're saying is that there’s-- First of all, you want to apply for it early before you ever think you even need it, because there's a waiting list of a period of time.
Amy: That's right. You need to get educated as to how long the waiting list is, what the waiting list criteria is. All care in Florida is measured on what what's called ADLs. If you're out there, get used to this term, Activities of Daily Living, bathing, dressing, toileting, feeding, transferring, walking. If you cannot complete your ADLs, if you're having ADL-dependency issues, that will help you qualify for Medicaid. There's medical eligibility and financial eligibility. We teach you what those eligibility criteria are. A lot of people that come to us, they're already eligible so they're already needing help with their ADLs. When we put them on the waiting list, they're actually ready right now, but they do have to wait.
Tom: If you want to qualify for a Medicaid waiver, is that a paper application, or is somebody talking to you over the phone and asking you questions? Are you going in somebody's office and answering questions? How is that decided?
Amy: There's paperwork filed with, locally, the Senior Resource Alliance. There's area agencies on aging and an agency in each area is devoted to being the waiting list holding company. Paperwork is filed and then a few weeks after that, there's a phone interview, where they review the medical criteria and the medical eligibility of the person. Then they’re given a priority score and they're placed on the waiting list. If you're given a score of five, four or three, you're placed on the waiting list. If you're given a score of one or two, you don't get on the waiting list.
Tom: If you're given a score of five, is that going to give you a higher priority than somebody that scores a four?
Amy: Correct. If you're given a score of five, you immediately get the assistance.
Tom: If somebody's going to apply for a Medicaid waiver, it makes a difference on how they answer these questions, folks. You need a little bit of prep, you might say.
Amy: That's right. How many times have you had an older adult and you ask them questions about how they're doing and they go, "Great." “Can you do your own pants? Can you tie your shoes?” "Yes, I do a great job," and the child's looking at their parent going, "No, they can't do that." You absolutely need to know how to answer the question, and you're answering the question on your worst day. You don't brag and say, "This is my best day." You really plan for the worst, so you want to tell them how you're doing on your worst day. That requires support to really see how you're functioning.
Tom: Folks, we're talking about the Medicaid waiver here in the State of Florida. From Medicaid's perspective, they're saying, "Hey, we would rather pay somebody 5 to 30 hours a day to come help mom and dad at home, because it's less expensive than putting mom and dad in a nursing home."
Amy: That's right.
Tom: It’s a win for the government.
Amy: It's a win for the government. It's a win for the elder. We just had a call the other day. Somebody was in a nursing home and they wanted to go back home. They immediately qualified for Medicaid at-home because they were coming out of a nursing home already approved for Medicaid.
Tom: Nice. The other thing we want to know about this, first of all, you got to get financially qualified, and Robert Hidock is an attorney at our office that can help you do that. Number two, you want to know how to properly answer the questions to score a five on this exam, you might say.
Amy: That's right.
Tom: Then you want to do it early because even if you're a five, you might be a year or two out before this is available to you.
Amy: If you're a five, you immediately get it. If you're a four, you might have a long wait in front of you. Being a four, you still need help. There's not a lot of money available, but the message that I would want to get to the listener is get this information now before you think you need it.
Tom: You're calling it Medicaid at-home or a Medicaid waiver, what we're speaking of. Would you say that most people, when they apply for this, that most people end up being a four? Is that most common?
Amy: I would say that. I would say that. The interesting thing, we've had people that have been a four that were really a five. They just didn't answer the questions properly.
Tom: The point about this is that mom or dad, if they answer all the questions as we would hope that they would, they might very well score a four. You might want to go ahead and do that now, because as a four, they may not get this in-home care for a year or two.
Amy: That’s right.
Tom: You're thinking ahead is what we're really saying.
Amy: That's right. If you add the other layer of having a memory deficit, that gets even more complicated. Because you could say, "Can the person feed themselves?" and you think, "Well, they could actually pick up the fork and put it in their mouth, but they're not going to remember if they had lunch. They're not going to know what time it is." You really have to be very, very careful about how you answer the questions when they have a memory deficit.
Tom: All right, folks. My name is Tom Olsen. The name of the show is Olsen on Law. My guest today is Amy O'Rouke with O'Rouke & Associates. We're going to take a break. We'll be back in just a few minutes.