Minnesota home care programs

Home health: the medical benefit

In Minnesota, skilled home health is MHCP Home Health Agency 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 Minnesota 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 Minnesota the agency route is Community First Services and Supports — agency-provider model (CFSS). 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. Community First Services and Supports — agency-provider model (CFSS) 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

Minnesota's consumer-directed option is Community First Services and Supports — budget model and Consumer Directed Community Supports (CDCS). 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: Community First Services and Supports — budget model and Consumer Directed Community Supports (CDCS) 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

Minnesota has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Community First Services and Supports — budget model and Consumer Directed Community Supports (CDCS)), by the hour, as the participant's chosen aide.

Other ways Minnesota pays for care at home

Waiver in-home services: CADI, BI, CAC and DD waivers — in-home services (IHS) and Elderly Waiver (EW). 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: Alternative Care Program (AC). 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 (MHCP Home Health Agency Services).
• Needs daily help and wants an agency to supply and manage the aide: Community First Services and Supports — agency-provider model (CFSS).
• Wants to choose the aide, including a relative where allowed: Community First Services and Supports — budget model and Consumer Directed Community Supports (CDCS).
• Meets nursing-home level of care and needs more than personal care: CADI, BI, CAC and DD waivers — in-home services (IHS) and Elderly Waiver (EW).