Welcome to Nursing &Behavioral Health Services (NBHS) where we provide you with second-to-none Medicaid Waiver Help, is just a phone call away. Get expert Medicaid Waiver consultation! Do you need an expert consulting agency to help you become a Medicaid Waiver Provider? Do you desire to acquire Medicaid Certification for a Personal Care Home, Adult Day Program, Medical or Non-Medical Home Care Company?

Do you have Medicaid compliance issues or need help with a corrective action plan? Well, look no further!

Medicaid Waiver Help TODAY! Medicaid Waiver is a program that provides services to people who would otherwise be in an institution like a nursing home or hospital to receive long-term care. Before 1991, the Federal Medicaid program would only pay for services if the person was actually institutionalized. Since then, the Medicaid Waiver program has shifted to allow states to provide services to consumers in their homes and communities. The specific services available to qualified individuals with a disability is state-specific and will likely vary from state to state.

What are the different programs?

Medicaid Waiver programs allow low-income, qualifying individuals to benefit from quality personal care homes, host homes, adult day programs and other personal care services and not be institutionalized. Still, there is a variety of Medicaid Waiver programs and each one is somewhat unique from the others. Every program offers several core services such as:

  • Coordination services (helping with care needs and services management)
  • Personal support (assistance with activities of daily living (ADLs) like bathing, dressing, meals and housekeeping)
  • Home health services (nursing, home health aide, and occupational, physical and speech therapy)
  • Emergency response systems
  • Respite care (caregiver relief)

Waiver Program examples include:

The Service Options Using Resources in a Community Environment (SOURCE) program serves frail, elderly and disabled beneficiaries. In more specific terms, the goal of this program is to improve the health outcomes of persons with chronic health conditions, and it accomplishes this by linking primary medical care with personal care homes and community-based services through case management agencies. SOURCE program beneficiaries are enrolled with a SOURCE site as their primary care provider who coordinates all medical and social services. The primary advantage of this program is that it insures current gaps in Medicaid benefits for medical and supported living services are addressed, while other advantages include integrating all types of care instead of fragmenting them and limiting the use of emergency rooms and long-term institutional placement.

The Independent Care Waiver Program offer services that help a limited number of adult Medicaid members with physical disabilities to live in their own homes or in the community instead of a hospital or nursing home. It offers personal support and home care services, as well as specialized medical equipment and supplies. Alternative Living Services (ALS) is offered in a residential setting for those who qualify.

The Community Care Services Program provides community-based social, health and support services to eligible patients as an alternative to institutional placement in a nursing facility. Eligible consumers receive a combination of Medicaid-funded CCSP and other community services. The care coordinator assesses eligibility for CCSP, develops a consumer-focused comprehensive plan of care in collaboration with the primary physician, and arranges for delivery of services based on identified needs. The care coordinator monitors the services delivered to the program participant.

Equally, The New Options Waiver (NOW) and Comprehensive Supports Waiver Program (COMP) offers home- and community-based services for people with intellectual or developmental disabilities. This program works on providing comprehensive and intensive services, needed out-of-home residential support and supervision or intensive levels of in-home services to remain in the community for eligible individuals.

What are the benefits for individuals?

Since each Waiver request involves asking CMS to “waive” some of the rules that usually apply to Medicaid, it also allows states to create a particular set of services with flexible rules to meet the needs of people to individualize care per state. The services in each Waiver assist individuals to live in the community rather than in Medicaid funded institutional settings, such as nursing homes or institutions for people with intellectual and developmental disabilities. These Waiver options enable people to be more independent and integrated into their communities. Waivers are also great ways to help individuals become self-employed or run a small business. Combined with other subsidies such as Vocational Rehabilitation (VR) or Social Security’s Plan for Achieving Self Support (PASS), individuals with disabilities can find support to participate in their business instead of being assisted in participating in non-paid community activities.

Why serving Medicaid Waiver clients is a great business opportunity for your Personal Care Home

In Georgia, for instance, there are no particular fees to become a Medicaid Provider, however, it can be a rather lengthy process. The Department of Behavioral Health and Developmental Disabilities (DBHDD) recruits and qualifies a provider based on the needs of individuals. This recruitment and qualifying process is accomplished through the use of a pre-qualification process and an application process. Recruitment cycles occur two times per year, beginning July 1 and January 1 of each state fiscal year. Interested providers must submit a completed list of Pre-Qualifiers during the specified month of the Open Enrolment period.

Although the process can be long and tedious, the benefits it presents for your business equals and exceed the requirements. To begin with, this opens doors to an ever-increasing list of potential customers. In 2012, for instance, and just for COM programs, there were a little over 12,000 people benefiting from Medicaid Waiver programs. This is regardless of the waiting list which quickly drives up demand for Medicaid Waiver care providers. Just for 2012, there were 10,000 people on Georgia’s waiting list, and the state is working on a five-year plan to dramatically expand community services for people with mental illness and developmental disabilities.

In the same vein, Carolina is not much different with respect to fees; however, it has roughly 9,000 individuals in its Medicaid Waiver programs and a very lengthy waiting list of potential beneficiaries. Additionally, South Carolina, just like Georgia’s Waiver programs, provides opportunities for all sort of providers to go into business and deliver customized services to special populations. One very unique difference setting both states apart is that Georgia is currently requiring new providers to have held a contract providing services to be eligible to apply for a Waiver program. In contrast, South Carolina doesn’t have this stringent requirement, which makes it far easier to go into business there.

Medicaid certification is the process you must go through in order to obtain a “Provider Number” for your personal care business seeking to deliver any specific Medicaid Waiver services. This process is one that is totally different than obtaining state licensure to become a personal care home or home care company. However, in some states and with waiver programs, state licensure is a prerequisite to becoming Medicaid Certified. The “Certification Process” is not easy, but it is definitely one that is manageable and worthy of enduring. This is clearly the case since many personal care home providers are compensated for up to $1,100 daily for behavioral and medical needs, and there are several home care companies with multiple total care cases at $50 and $60 per hour – ranking in excess of $500 per day per 24-hour total care cases.

Being eligible to provide Medicaid Waiver services also represents an additional source of revenue for your business with no growth limitations. Indeed, Medicaid Waivers are an excellent source for starting and growing a personal care business. But make no mistake, certification and monitoring are very intense. Just as you were certified, you can be stripped of your certification and placements may be halted for health and safety reasons.

NBHS is an expert with over 2 decades experience in providing strategic advice to start-ups targeted at not only surviving the first two years-most challenging time of a business- but for the long haul. We help with licensing and certification of personal care programs in all states. That’s right and with more than 20 years of experience, we can help transmute your personal care business from the dreamlandsinto reality in any state. Do not hesitate to contact us to reduce the waiting time to start your business.

Contact us now to schedule a phone consultation to discuss your project or retain us to research your Medicaid Waiver specific business interest in your state of choice.

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