Medicaid and Personal Emergency Response Services / Personal Safety Monitors

Introduction

Does Medicaid pay for Personal Emergency Response Services (PERS)?  The short answer is yes, but the question is significantly more complicated.  Which Medicaid programs pay for medical alert devices (PERS)?  Which ones do they pay for?  Will they cover hardware or the ongoing service costs or both?  What defines a PERS / Medical Alert device and can the advanced features available in today's electronic safety and fall monitoring systems even be considered simply a PERS?  To be explore this topic more fully, it helps to begin with a description of this category which we'll call Personal Safety Monitoring.

49 states and D.C offer financial assistance for home safety monitoring of the elderly.

 

Personal Safety Monitoring / PERS Description

Personal Safety Monitors encompasses a wide suite of products from the most basic, wearable pendant with a call button to the advanced network of in-home sensors that monitor movement, activity and even some vital signs and report that data in real-time to caregivers, family members and emergency responders.

The simplest and least expensive services are formally referred to by most Medicaid programs as Personal Emergency Response Services. However, they are more commonly called life alerts, medical alert or fall monitors. The more robust systems may be called a variety of names such as electronic home monitoring, telemonitoring or more generically, aging in place technologies.  More on how these systems work.  

 

Medicaid Payment Options

Our organization has identified four different categories of programs within Medicaid that offer funding for electronic safety monitoring for the elderly. There are also non-Medicaid sources of financial assistance for PERS devices.

 Did You Know?  Seniors and their family member can receive free quotes for PERS devices including ones with fall detection.  Start here.

Medicaid Waivers

Probably the most popular source of funding, especially for lower end monitors, are Medicaid's Home and Community Based Services (HCBS) waivers or 1915 waivers. Waivers often simply offer Personal Emergency Response Services as a standard included benefit. Each state has its own waivers and each waiver, its own policy. Our research finds the funding amounts for PERS services ranged from $25 - $75 / month.  Many state waivers also offer a single reimbursement of between $40 - $200 intend to cover any installation or startup fees associated with a PERS service.  A complete list of Medicaid waivers that offer PERS benefits to help the elderly remain living at home is available here.

 

Consumer Directed Services

Many state Medicaid programs allow for consumer direction of services.  What this means is Medicaid provides elderly participants with funding to be used for care but does not necessarily dictate the types of care or care providers the beneficiary must use.  Therefore, under consumer direction, participants can pay for PERS or more advanced medical alert devices without Medicaid necessarily having to approve it.  As consumers control their budget, they can elect to pay for higher end systems especially if these systems reduce the need for other Medicaid funded services.  As an example, a beneficiary may choose a PERS device with a medication management service associated with it.  The additional $30 / month for medication management might reduce the individual’s need for several hours per week of home care, therefore the additional cost lowers the overall cost of care.

 

Medicaid State Plan PCA Programs (Personal Care Attendant)

Personal Care Attendant programs are best thought of as regular Medicaid entitlement programs, as opposed to services received under limited enrollment Medicaid HCBS Waivers.  Some state's PCA programs offer PERS as a standard or as a consumer directed service.  Typically, PCA programs will pay the same amounts as HCBS Waivers, approximately $25 - $75 / month and $45 - $200 for one-time startup fees.  

 

Money Follows the Person

This unusually named program is designed for Medicaid beneficiaries that currently reside in nursing homes.  The program's goal is to move residents from nursing homes back to their homes or into the home of their caregivers or other loved ones.  As such, the program will pay for a variety of services, assistive technology and home modifications that help participants to function in a home environment including home safety monitoring / PERS services.  Worth noting is that Money Follows the Person programs often have different names in different states and all but six states participate in the program (those which do not are AK, AZ, NM, OR, UT and WY).

 

List of State Medicaid Programs Providing Financial Help

Note, this list is not comprehensive but instead includes those Medicaid programs which are relevant to the elderly.  As an example, Medicaid waivers that pay for PERS but target developmentally disabled persons exclusively are not included here. 

State

Program / Waiver Names Covering PERS (updated May 2017)

Alabama

SAIL Waiver

Alaska

Alaskans Living Independently and the Adults with Physical & Developmental Disabilities Waiver

 

Arizona

Arizona Long Term Care System and Agency With Choice Program 

Arkansas

Elder Choices and Independent Choices

California

Nursing Facility/Acute Hospital Waiver and Multipurpose Senior Services Program

Colorado

Elderly, Blind and Disabled Waiver

Connecticut

Personal Care Assistant Program and Community First Choice Option

Delaware

Diamond State Health Plan Plus

Florida

State Medicaid Managed Long Term Care

Georgia

SOURCE and Community Care Services Program

Hawaii

Med Quest (formerly called Quest Expanded Access)

Idaho

Aged & Disabled Waiver

Illinois

HCBS Waiver for Persons who are Elderly and HCBS Waiver for Supported Living and My Choices Project

Indiana

Aged and Disabled Waiver

Iowa

HCBS Elderly Waiver and Health and Disability Waiver

Kansas

HCBS Waiver for the Frail Elderly

Kentucky

Aged and Disabled Waiver

Louisiana

Community Choices Waiver

Maine

Elderly and Adults with Disabilities and Consumer Directed Personal Assistance Services

Maryland

Older Adults Waiver and Community First Choice Program 

Massachusetts

Frail Elder Waiver

Michigan

Choice Program

Minnesota

Elderly Waiver and Community Access for Disability Inclusion Waiver

Mississippi

Assisted Living Waiver and the Independent Living Waiver

Missouri

No coverage for elderly persons

Montana

HCBS Waiver and Self Directed PAS

Nebraska

HCBS for Aged & Adults with Disabilities

Nevada

Frail Elderly and HCBS for Persons with Disabilities and the HCBW for Persons with Physical Disabilities

New Hampshire

Choices for Independence

New Jersey

Managed Long Term Services and Supports (MLTSS) and Personal Pref. Program

New Mexico

Centennial Care Community Benefit

New York

Long Term Home Health Care Program and Consumer-Directed Personal Assistance

North Carolina

CAP Choice Waiver

North Dakota

HCBS Medicaid Waiver

Ohio

Passport Waiver and MyCare Ohio

Oklahoma

ADvantage Program

Oregon

Independent Choices and the K Plan

Pennsylvania

HCBW for Individuals Aged 60 & Over and Services My Way

Rhode Island

Global Consumer Choice CompactPersonal Choice Program and Home and Community Care Waiver

South Carolina

Community Choices Waiver and Community Supports Waiver

South Dakota

Elderly Waiver

Tennessee

Choices in Long Term Care

Texas

Star Plus Waiver and Community First Choice Program

Utah

UT New Choices and Aging Waiver

Vermont

Global Commitment to Health Waiver and High Technology Home Care

Virginia

Elderly or Disabled with Consumer Direction and Technology Assisted Waiver

Washington

Community First Choice Option and New Freedom Program and COPES 

Washington DC

Elderly and Persons with Disabilities Waiver

West Virginia

Aged & Disabled Waiver

Wisconsin

COP-W Waiver and IRIS and and Family Care

Wyoming

Community Choices Waiver