Maine home care programs

Home health: the medical benefit

In Maine, skilled home health is Home Health Services (MaineCare Section 40). 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 Maine Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

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 Maine the agency route is Private Duty Nursing and Personal Care Services (Section 96) (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. Private Duty Nursing and Personal Care Services (Section 96) (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

Maine's consumer-directed option is Consumer Directed Attendant Services (Section 12) (CDAS) and Section 19 Participant-Directed Option (PDO). 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: Consumer Directed Attendant Services (Section 12) (CDAS) and Section 19 Participant-Directed Option (PDO) 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

Maine has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Consumer Directed Attendant Services (Section 12) (CDAS) and Section 19 Participant-Directed Option (PDO)), by the hour, as the participant's chosen aide.

Other ways Maine pays for care at home

Waiver in-home services: Home and Community Benefits for the Elderly and Adults with Disabilities (Section 19) — agency model. 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: Home Based Supports and Services for Older and Disabled Adults (Section 63) and Independent Support Services (Section 69). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services (MaineCare Section 40)).
• Needs daily help and wants an agency to supply and manage the aide: Private Duty Nursing and Personal Care Services (Section 96) (PCS).
• Wants to choose the aide, including a relative where allowed: Consumer Directed Attendant Services (Section 12) (CDAS) and Section 19 Participant-Directed Option (PDO).
• Meets nursing-home level of care and needs more than personal care: Home and Community Benefits for the Elderly and Adults with Disabilities (Section 19) — agency model.