What To Except During Medicaid Health Needs Assessment

Daisie

Hi. I signed my mom up for Medicaid with our local Office of Aging and finally got the financial assessment done yesterday. The in-home health needs assessment is in a few weeks.

Can anyone enlighten me on what to expect? Are they pretty perceptive at knowing when someone with MD is "masking" and making it seem a lot better than it really is (due to anosognosia)?

Any insight would be greatly welcomed and appreciated!

Peace!

M1

Daisie you should drive the interview, not her, and an experienced person will know this. They will ask general questions about her conditions but then will also want detailed information on what help she needs with activities of daily living (ADL's- including bathing, dressing, grooming, toileting, walking, eating) and instrumental activities of daily living (IADL's, including finances, telephone use, cleaning, shopping, transportation, meal preparation, laundry). They will use this information as well as information about you (such ad your work commitments) and any other supports to come up with a plan of how much assistance she might be eligible for.

Jeanne C.

I agree with M1. One piece of advice is when discussing ADLs, keep in mind the most help you have to give. For example, if your mother needs help toileting sometimes, the answer is "yes, she needs help toileting."

mabelgirl

We went through this in tha past year. There was an assessment done where although Mom participated the assessor looked for input from me for confirmation and clarity. They immediately picked up on my mom’s anosognosia. As mentioned just be honest with yourself as far as what you do for your mom. When we were discussing mom’s cooking / food preparation it kinda hit , hey she’s not even making her tea anymore even with all the written cues. They are familiar questions they asked and they do not ask for demonstrations.

M1

One more thing, they tend to quantify the amount of disability as mild, serious, or total- and then have maximum amounts of time they will assign for each category. For example, for someone who is totally disabled from bathing, they may allow 30 minutes a day for a bath (gross underestimates, i know, but this is what they do). There will be maximum amounts of time allowed for each activity (ie, 30 minutes a day to help someone who is completely incontinent, or 90 minutes a day to fix meals for someone completely unable to do meal prep). The maximum amount of care allowed is still pretty minimal, in my state its about 27 hours per week unless approved by an insurance director to prevent nursing home placement.

If there are multiple managed care organizations providing Medicaid services, the amount of home care they will cover can also vary significantly. There are three Medicaid options in our state; one is very generous and rarely denies care, one is notoriously skimpy, and the third does almost exclusively pediatric cases. So that may also be something you want to explore if you have a choice. Here, you don't have a choice who you are initially assigned to, but after a year you can change during your assigned open enrollment window.

Daisie

Yes, I've been told to use the worst day possible as my guide and pretty much act like that's how it is every day. I just worry that they will assume I can do it all. I can't. I have to work, and it's started interfering with the quality of work I produce, even though I WFH. I know that I will also have to look for a different job after the first of the year, and chances are it will be at least a hybrid job, and I will need to be in the office a few days a week. My current job also wants me to visit their offices (a state away) and there's no way I can right now. Regardless, the emotional toll is getting unbearable. I never get a break from it. I'm pretty much with my mom 24/7.

housefinch

2 thoughts: (a) definitely be very clear about exactly what you have to do to help her (eg “if I don’t watch her as I hold her hand, she will walk into a street sign” for example—-this is what I said about my own child, to indicate the degree of inattention and lack of safety awareness. I’m saying this because even professionals often do not understand the degree of assistance you are giving. If you imagine what your mom would do without your help for X ADL, that can help you fill in those gaps.)

(b) unless things are different in the adult world, I’m wondering if you should get her qualified for long term care Medicaid to get her on a list for a local skilled nursing facility? To help you be able to hold a job. Believe me when I say I know the toll caregiving can take on a career. I left my intense professional job several years ago because of unrelenting caregiving stress for a different reason (child—-I also have a PWD in my close family). It’s so stressful when it impacts your job performance/attendance. I have a profession with full on-site expectations and really feel for you ❤️❤️❤️. You don’t want to set yourself on fire (damage your long term earning and retirement savings potential) to keep your mom warm—especially if placing her, as hard as it might be, would help you have a life. I hope you get it sorted out so you can feel better.