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Free Medical Alarm Systems! Medicaid Benefit Guide By State Introduction

Free Medical Alarm Systems. Medicaid Benefit Guide By State Introduction

Free Medical Alarm Systems! Medicaid Benefit Guide By State

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)? 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? Can the advanced features available in today’s electronic safety and fall monitoring systems even be considered simply a PERS? To explore this topic more fully, it helps to begin with a description of this category, which is more broadly referred to as 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 alarm, help alerts, 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. 

For a list of affordable, professionally monitored medical alarm or caregiver monitored help alert systems, CLICK HERE.

Medicaid Waivers

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(c) 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 intended to cover any installation or startup fees associated with a PERS service. A list of Medicaid waivers that offer PERS benefits to help the elderly remain living at home by state is below. 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.

List of State Medicaid Programs Providing Financial Help

Note, this list is not comprehensive, but instead includes only those Medicaid programs that 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.

State

Program / Waiver Names Covering PERS (updated October 2019)

Alabama

SAIL Waiver and ACT Waiver

Alaska

Alaskans Living Independently

Arizona

Arizona Long Term Care System and Agency With Choice Program 

Arkansas

Independent Choices and the new AR Choices Program

California

Home and Community Based Alternatives Waiver and Multipurpose Senior Services Program

Colorado

Elderly, Blind and Disabled Waiver

Connecticut

Personal Care Assistant Program

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 ElderlyHCBS Waiver for Supported LivingCommunity CareHealthChoice Illinois and Medicaid-Medicare Alignment Initiative

Indiana

Aged and Disabled Waiver

Iowa

HCBS Elderly Waiver

Kansas

HCBS Waiver for the Frail Elderly

Kentucky

Aged and Disabled Waiver

Louisiana

Community Choices Waiver

Maine

Elderly and Adults with Disabilities

Maryland

Community Options WaiverCommunity First Choice Program  and the Increased Community Services Program

Massachusetts

Frail Elder Waiver (for some participants)

Michigan

Choice Program and Health Link Program 

Minnesota

Elderly Waiver and Community Access for Disability Inclusion Waiver

Mississippi

Assisted 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 ProgramAssisted Living Program and Community First Choice Option

North Carolina

CAP Choice Waiver

North Dakota

HCBS Medicaid Waiver

Ohio

Passport Waiver and MyCare Ohio

Oklahoma

ADvantage Program

Oregon

K Plan

Pennsylvania

HCBW for Individuals Aged 60 & OverServices My Way, and HealthChoices Program

Rhode Island

Global Consumer Choice Compact

South Carolina

Community Choices Waiver

South Dakota

HOPE 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 CFC Moderate Needs Group

Virginia

Commonwealth Coordinated Care (CCC) Plus Waiver

Washington

Community First Choice OptionNew Freedom ProgramCOPES, and Medicaid Alternative Care Program

Washington DC

Elderly and Persons with Disabilities Waiver

West Virginia

No coverage

Wisconsin

IRIS and Family Care

Wyoming

Community Choices Waiver

Costs & Pricing Structures

Personal safety monitors use one of three pricing models: (1) One-time equipment purchase. (2) Monthly service fee or 3) start up / equipment fee plus monthly service.   The first model is rarely used. It is much more common to have a flat monthly fee, which incorporates the rental of the monitoring equipment or for the user to buy the equipment outright and pay a lower monthly fee.

Service Type

Description

Cost

Basic Service

Wearable pendant to a call center for emergency response

$25 – $50 / month

Mid Range

Pendant / watch with automated fall detection, call center, emergency response, family notification

$30 – $60 / month

High End

Wearable device, multiple in-home sensors, two-way communication, online reporting, emergency response, multi-party notification and add-ons

$500 – $1000 startup and $50 – $100 / month

Payment Options and Financial Help

Financial assistance is available to help pay for home safety monitoring and PERS devices for the elderly.  A variety of different sources exist but not all options are available to all families.

Seniors and their family members are eligible for free quotes for PERS devices including ones with fall detection.  Start here.

Medicare and Private Health Insurance

Does Medicare pay for medical alert services? This is almost everyone’s first question. Unfortunately, the cost savings potential of these services has yet to be recognized by original Medicare. Original Medicare, Medicare supplemental insurance (Medigap), and most private health insurance plans do not cover PERS, Medical Alert devices, or any other form of personal safety monitoring for seniors. However, April 2, 2018, the Centers for Medicare and Medicaid Services (CMS) made strides when they announced they are allowing Medicare Advantage, also called Medicare Part C, providers to expand supplemental benefits to include healthcare benefits beginning in 2019. The term “healthcare benefits” is loosely defined, but must be deemed medically necessary. This includes items and services for prevention, diagnosis, and treatment of sicknesses and injuries. Based on the loose guidance about what can and cannot be considered a health related supplemental benefit, it is our interpretation that some Medicare Advantage providers in some states will pay for medical alert devices. Please note that Medicare Advantage plans differ based on the state and insurance provider. So it is important to compare plan benefits to see if this benefit is included.

Veterans’ Options

Veterans have two different options for financial assistance for medical alerts. Although neither of these programs are specifically intended for this purpose.  Veterans Directed Home and Community Based Services provide veterans with a care budget and the flexibility to use that budget as they best see fit to help avoid nursing home placement.  As home monitoring clearly contributes toward that goal, Medical Alert / PERS would be considered an eligible expense.  The second option is the veteran’s pension benefits known as Aid and Attendance and Homebound.  These benefits are intended for veterans or their surviving spouses who require assistance with the activities of daily living and / or are housebound.  Use of the cash assistance is at the discretion of the beneficiary or their caregivers / family members. Therefore, it can be used to pay for home safety monitoring.

Tax Deductibility

The question of whether Medical Alert / PERS devices and services are tax deductible is open to some interpretation. However, the consensus (though not necessarily an “overwhelming consensus”) is that PERS / Medical Alerts can be considered medical expenses and are, therefore, deductible. As other assistive technology and capital expenses for home modifications are deductible, a strong case can be made for the deductibility of Medical Alert services. The actual tax code makes no mention either for or against PERS devices.

For a list of affordable professionally monitored medical alarm or caregiver monitored help alert systems, CLICK HERE.