When the citizens of Missouri voted to expand Medicaid coverage in August, they envisioned expanded access to insurance for 230,000 citizens who would not qualify under the existing income requirements.
The Missouri Medicaid program — MO HealthNet — offers coverage for medical, dental and vision care, as well as other services for children, low income individuals and families, the blind and the disabled.
For these individuals, the new coverage will provide an important safety net, which is crucial with the pandemic affecting access to safe medical care amid rising unemployment.
For elderly and disabled individuals at risk of needing nursing home care, this expansion includes valuable options for in-home care that can help them stay healthier while avoiding COVID-19 exposure.
With as many as 40% of U.S. COVID-19 deaths potentially linked to nursing home-acquired infections, avoiding nursing home admissions wherever possible is critical for health care providers working with disabled and elderly patients.
Avoiding long-term care has been a goal for health care professionals as evidence shows that the right in-home services can keep patients healthier and happier longer, and at a lower cost to insurers, both public and private.
But for many Missouri families, this care was not financially possible to provide, or desirable, without the Medicaid expansion and before the COVID-19 pandemic.
Amid the pandemic and accompanying recession, we have seen families regroup, and their decisions have clearly changed when it comes to helping their elderly and disabled family members avoid COVID-19 exposure.
With the recession driving higher unemployment, able-bodied family members are more available and willing to provide care at home. Funding for in-home care created by existing programs, and the additional eligibility for programs created by the Medicaid expansion will allow more Missouri families to build multi-generational living arrangements.
This also allows them to avoid nursing home care while providing safe, in-home jobs for friends and family members who need employment and want to help.
However, these programs can be a challenge to navigate. Determining eligibility, working with physicians to ensure the right services and level of care, guaranteeing caregivers are paid and that reporting and ongoing compliance are maintained so they can continue to be paid, is complicated.
Most self-directed caregivers rely on an agency to support these activities, but finding the right agency and options in an industry rife with poor customer service and outright fraud can be a challenge.
These agencies have become even more important with COVID-19 in the mix, as they have the ability to help families with guidelines and support for ensuring the safety of in-home care recipients as well as compliance and payment for caregivers.
Since the onset of the COVID-19 pandemic in April, managed care agencies, including the company I work for — Emerest — have seen the client lists grow, as they support new recipients resulting from the pandemic initially, and the Missouri Medicaid expansion most recently.
COVID-19 has made care delivery more complicated across all care settings, and in-home care has not been left out of the challenge.
In-home care provides significant benefits to both caregivers and patients when it’s done well, but without the right support it can be stressful and create strains on families.
Today’s in-home caregivers need access to services that ensure compliance, provide fair and timely compensation, and more importantly, offer customer service that lets caregivers and patients direct their own care with the education and support needed in this confusing and challenging time.
At Emerest, our in-home caregivers ensure the best care for our state’s most vulnerable residents.
Nate Cohn is the Missouri administrator at Emerest, a home care and specialized health care services company.