Idaho home care programs

Home health: the medical benefit

In Idaho, skilled home health is Home Health Services. It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Idaho Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Idaho the agency route is Personal Care Services (PCS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. Personal Care Services (PCS) lets the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

Idaho's consumer-directed option is Adult Developmental Disabilities Waiver and Participant-directed A&D Waiver services through a Fiscal Intermediary (FI). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Adult Developmental Disabilities Waiver and Participant-directed A&D Waiver services through a Fiscal Intermediary (FI) allow a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Idaho has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Adult Developmental Disabilities Waiver and Participant-directed A&D Waiver services through a Fiscal Intermediary (FI)), by the hour, as the participant's chosen aide.

Other ways Idaho pays for care at home

Waiver in-home services: 1915(i) State Plan HCBS Benefit for Children with Developmental Disabilities and Aged and Disabled Waiver. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

State-funded: Senior Services and Older Americans Act in-home services. Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Also: Medicare Medicaid Coordinated Plan (MMCP) and Idaho Medicaid Plus (IMPlus) and Private Duty Nursing (PDN).

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services).
• Needs daily help and wants an agency to supply and manage the aide: Personal Care Services (PCS).
• Wants to choose the aide, including a relative where allowed: Adult Developmental Disabilities Waiver and Participant-directed A&D Waiver services through a Fiscal Intermediary (FI).
• Meets nursing-home level of care and needs more than personal care: 1915(i) State Plan HCBS Benefit for Children with Developmental Disabilities and Aged and Disabled Waiver.