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.

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.

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.