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Issue Alert - 04-02-01

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Date:

Feb 09, 2004

Issue Summary:

Only individuals who require help with Activities of Daily Living (ADLs) will be able to qualify for Home Help Services (HHS) under new HHS policy, and new maximums are established for the number of hours of HHS an individual may receive for help with Instrumental Activities of Daily Living (IADLs). HHS recipientsÂ’ medical need must be re-certified on an annual basis.

Persons Affected:

Home Help Services applicants and recipients.

For More Information:

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000(734) 998-6100Fax: (734) 998-9125


Background

Medicaid - Home Help Services (HHS)

What's Happening?

New policy has been issued by the Department of Community Health (DCH), in Beneficiary Eligibility Bulletin, Health Care Eligibility Policy 04-01, dated January 15, 2004, and effective March 1, 2004. The bulletin is available online at http://michigan.gov/documents/HCEP_04-01_83527_7.pdf (or go to http://michigan.gov/mdch and select "Medicaid Policy" under "Feature", at the bottom of the home page). Revised FIA policy had not been issued at the time this Alert was prepared.CHANGE IN ELIGIBILITY REQUIREMENTS:
  1. ANNUAL RE-CERTIFICATION OF MEDICAL NEED: Effective March 1, 2004, in order to be eligible for HHS, the individual must submit a certification of medical need (FIA 54A form) on an annual basis. The form may be completed by a physician, occupational therapist, physical therapist, or nurse practitioner. Ongoing recipients will have to submit an updated FIA 54A at their next redetermination.
  2. NEED FOR ASSISTANCE WITH ADL: Effective March 1, 2004, in order to be eligible for HHS, the individual must require assistance with at least one ADL. Individuals who only require assistance with IADLs no longer will be eligible for HHS. For ongoing recipients, eligibility will be reviewed under the new criteria at their next redetermination.The individual does NOT have to be requesting HHS for the ADL in order to establish the need. The need for assistance with an ADL may be shown by:a) FIA Adult Services Worker authorizationb) Relatives, friends, or others providing ADL assistance without chargec) Use of assistance technology to perform the ADL, as documented by the FIA Adult Services Workerd) Exception granted by DCH Long Care Systems Development Section.
CHANGE IN AMOUNT OF SERVICES:New limits are imposed on the number of hours of help that will be paid for by HHS for certain IADLS. The new maximum monthly hours are: 5 hours for shopping; 7 hours for laundry; 6 hours for housework; 25 hours for meal preparation.DOES THE CHANGE IN ELIGIBILITY COMPLY WITH FEDERAL MEDICAID LAW?The new policy refusing HHS for IADLs to recipients who do not also need assistance with ADLs may violate federal Medicaid law. Under 42 CFR 440.240(b)(1), the Medicaid agency must provide services that are equal in amount, duration, and scope for all categorically needy (Group1) Medicaid recipients, and for all Medicaid recipients within a particular medically needy (Group 2) group. Under the HHS policy, the state agency refuses to provide HHS for IADLs to some recipients (i.e. those who do not need help with an ADL) while providing HHS for IADLS to other recipients (i.e. those who need help with an ADL as well as an IADL). Thus, the new policy appears to deny an equal amount in duration and scope of HHS for IADLs, in violation of federal Medicaid law.For example, an SSI recipient (categorically needy Medicaid recipient) who needs direct physical assistance with grooming (an ADL) and with shopping (an IADL) would be eligible for HHS for shopping. However, an SSI recipient (categorically needy Medicaid recipient) who needs physical assistance with shopping (an IADL) but does not need assistance with any ADLs would not be eligible for HHS for shopping. Thus, an equal amount duration and scope of HHS for shopping is not available to all categorically needy Medicaid recipients. This situation is analogous to denying a recipient Medicaid coverage for an x-ray because the recipient does not also need an MRI.

What Should Advocates Do?

Share information about the changes with clients who have HHS and may experience changes at their next redetermination.Assist clients who need help getting verification of their need for assistance with ADLs. Provide information about hearing rights to clients who are denied HHS or are notified that their HHS is being reduced or terminated. CLIENTS WHOSE HHS IS BEING TERMINATED OR REDUCED MAY BE ELIGIBLE FOR HHS AT THE PREVIOUS LEVEL IF THEY REQUEST A HEARING WITHIN 11 DAYS OF THE DATE ON THE NOTICE. FIA must receive the original, signed hearing request within 11 days of the date on the notice in order for HHS to continue at its previous level. The final deadline for requesting a hearing is 90 days after the date of the notice. Encourage clients to get legal help if they are denied HHS or their HHS is reduced or terminated.

What Should Clients Do?

Seek legal advice if you are denied HHS, or your HHS is reduced or terminated.Remember that you must submit an original, written hearing request within 11 days of the date on the notice in order to maintain HHS at your current level, if your HHS is being reduced or terminated.Remember that you cannot request a hearing more than 90 days after the notice that your HHS is denied, reduced, or terminated.

Finding Help

Most legal aid and legal services office handle these type of cases, and they do not charge a fee. You can locate the "free" legal services or legal aid office that serves your county on the Michigan LawHelp website (www.MI.LawHelp.org) or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.