Page Reviewed / Updated - Apr. 2018
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)? For which devices or services do they pay? 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.
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.
There are four different categories of programs within Medicaid that offer funding that can be used to pay for electronic safety monitoring for the elderly (therefore for PERS / medical alert services). There are also non-Medicaid sources of financial assistance for PERS devices.
Probably the most popular source of funding, especially for less expensive, lower end medical alert services, 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.
It is also worth noting that many waivers include a general benefit referred to as “assistive technology”. How assistive technology is defined can vary by state. While a waiver might not outright state that it pays for Personal Emergency Response Services, an argument can be made that PERS is a form of assistive technology in that it decreases an individual’s dependence on others.
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 of medication management lowers the overall cost of care.
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.
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).
Note, this list is not comprehensive but instead includes only those Medicaid programs which are relevant to the elderly. To be clear, there are Medicaid waivers that pay for PERS but target developmentally disabled persons exclusively. These waivers / programs are not included in the list that follows.
Program / Waiver Names Covering PERS (updated April 2018)
Med Quest (formerly called Quest Expanded Access)
Frail Elder Waiver (for some participants)
No coverage for elderly persons