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Senate of Pennsylvania
Session of 2017 - 2018 Regular Session


Posted: June 30, 2017 08:58 AM
From: Senator Michele Brooks and Sen. Sharif Street
To: All Senate members
Subject: Presumptive Eligibility Legislation for In-Home Care
In the near future, I will be introducing legislation to give our loved ones greater opportunities to remain in their own homes instead of being admitted to nursing home care.

Currently, when a person applies for Medicaid, he or she can be “presumed eligible” for nursing home services and receive those services immediately, while the Medicaid application is being fully reviewed. However, if the applicant wishes to receive in-home care, he or she must wait until the application is fully approved, which could take months. Often this delay sends an applicant into nursing home care when the home setting would have been more appropriate, less expensive, and more rewarding for the applicant.

My bill will provide greater access to in-home care by extending “presumptive eligibility” to those who meet the qualifications for Medicaid and who wish to remain in their home instead of in a more costly and restrictive setting.

As many of us know from our own experiences, studies have shown that more than 90 percent of senior citizens wish to remain at home as they age. http://bit.ly/2u3LJqu

Not only does the at-home setting improve their quality of life; it saves tax dollars. The Commonwealth saves an estimated $34,000 a year for every person who is served in the home instead of in a long-term care facility. According to the Pennsylvania Homecare Association, loved ones receiving in-home care cost, on average, $31,000 per person a year, while the nursing home resident’s care paid for by Medicaid reaches approximately $65,148 per person per year.

Please be assured that the qualifications for care still remain in place. This bill will not alter or lower standards for care eligibility. Instead, it will assist in expediting and equalizing the approval process for those who wish to receive in-home care, as the process now does for nursing home care. As it now stands, delays in approving eligibility are a steep barrier to the management of long-term care resources and the timely access to home-based services.

Acknowledging that simplifying eligibility and expediting determinations will avoid unnecessary nursing home placement, Kentucky, New Jersey and 6 other states have presumptive eligibility for in-home care.

Please join me in correcting this disparity in presumptive eligibility, so that our seniors applying for Medicaid can receive the care they qualify for, in the setting they prefer, conserving taxpayer resources while honoring their wishes for independence and dignity.

Introduced as SB912