By Carl Zacharia
After working as an elder law attorney for many years, I can honestly say that I am still surprised by the number of people who are unaware of the long-term care options available to them. Unfortunately, this particular topic is usually not on someone’s radar until they are faced with making a care decision for themself or a loved one, and then it becomes overwhelming. I am often asked about the programs available to help seniors and individuals with disabilities access the care they need. In this article, we’ll explore three key options: Medicaid Waiver, ICP Medicaid, and the PACE program, with a special focus on the latter and its local provider, Hope PACE. This article does not outline every available option, but instead focuses on benefit programs that will pay, or help to pay, for long term care though Medicaid.
Medicaid Waiver
The Medicaid Waiver program, also known as the Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC), is designed to provide home and community-based services to eligible individuals who would otherwise require nursing facility care. This program allows recipients to receive care in their homes or communities, often delaying or preventing the need for institutional care. Eligibility for this program is based on both financial criteria and the level of care needed.
Key features of the Medicaid Waiver program include:
. Personal care services
. Home health aide services
. Homemaker services
. Adult day care
. Respite care
. Medical equipment and supplies
ICP Medicaid
Institutional Care Program (ICP) Medicaid is designed for individuals who require long-term care in a nursing home setting. This program covers the cost of nursing home care for eligible individuals who meet both financial and medical criteria.
ICP Medicaid provides:
. Nursing home care
. Physician services
. Hospital services
. Prescription drugs
While ICP Medicaid is essential for those who require intensive, round-the-clock care, many seniors prefer to avoid or delay nursing home placement if possible.
PACE Programs
The Program of All-Inclusive Care for the Elderly (PACE) is an innovative model that provides comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing home care but wish to remain in their communities. PACE represents a shift towards more integrated, person-centered care that aims to keep seniors independent for as long as possible.
Key aspects of PACE include:
. Comprehensive medical care
. Social services
. In-home care and support
. Adult day care
. Transportation to medical appointments
. Prescription drug coverage
. Therapy services (physical, occupational, and speech)
. Meals and nutritional counseling
. Recreational and social activities
One of the most significant advantages of PACE is its all-inclusive nature. Unlike traditional fee-for-service models, PACE providers receive a set amount per participant to provide all needed care. This incentivizes keeping participants healthy, and in the community, rather than in costly institutional settings.
Hope PACE: Our Local PACE Provider
In our area, Hope PACE is the designated provider for the PACE program. Hope PACE has established a strong reputation for delivering high-quality, compassionate care to eligible seniors in the community.
Hope PACE offers:
1. A team-based approach: Each participant works with a dedicated team of healthcare professionals who collaborate to provide personalized care.
2. PACE Center: A central location where participants can receive medical care, participate in social
activities, and enjoy nutritious meals.
3. In-home services: For those who need assistance at home, Hope PACE provides necessary services to help maintain independence.
4. Flexibility: Care plans are regularly reviewed and adjusted based on the changing needs of each participant.
5. Family support: Hope PACE recognizes the importance of family caregivers and provides education and support to help them in their roles.
To be eligible for Hope PACE, individuals must:
. Be 55 years or older
. Live in the service area
. Be certified by the state as needing a nursing home level of care
. Be able to live safely in the community with PACE support
It’s important to note that while enrolled in PACE, participants agree to receive all their health care services through the PACE organization, except in emergencies.
Choosing the Right Option
Deciding between Medicaid Waiver, ICP Medicaid, and PACE depends on individual circumstances, including:
. Level of care needed
. Desire to remain in the community
. Family support system
. Financial situation
As someone who is familiar with all of the different options, I recommend thoroughly exploring all of them and consulting with an elder law attorney, healthcare providers and family members before making a decision.
For many seniors in our area, Hope PACE offers an excellent balance of comprehensive care and community living. It’s worth considering for those who qualify and wish to maintain their independence while receiving all-inclusive care.
Remember, the goal of all these programs is to ensure that seniors and individuals with disabilities receive the care they need in the most appropriate and least restrictive setting possible. Whether through Medicaid Waiver, ICP Medicaid, or PACE, Florida offers several great options to support our aging population and their caregivers.
For more information on long term care and estate planning issues, contact Zacharia Brown’s Bonita Spring office at 239.345.4545
Zacharia Brown
Estate Planning and Elder Law Attorneys
Bonita Springs
26811 South Bay Drive, Suite 260
Bonita Springs, FL 34134
(239) 345-4545
Lakewood Ranch
8470 Enterprise Circle, Suite 300
Lakewood Ranch, FL 34202
(239) 345-4545