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Senate of Pennsylvania
Session of 2019 - 2020 Regular Session


Posted: December 5, 2018 04:20 PM
From: Senator Michele Brooks and Sen. Sharif Street
To: All Senate members
Subject: Deemed Eligibility for In-Home Care
In the near future, Sen. Street and I will be re-introducing legislation to give our loved ones greater opportunities to remain in their own homes instead of being admitted to nursing home care.

This legislation, Senate Bill 912 of the 2017-2018 session, will make it easier for seniors to access long-term services and supports and stay healthy at home, avoiding more costly institutional care. The bill allows providers to review an individual's finances quickly and use discretion to begin providing care immediately while that person waits for the lengthy Medicaid financial eligibility process to be completed.

Currently, when a person applies for Medicaid, he or she can be “deemed eligible” for nursing home services and receive those services without delay, 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 up to nine months. Often this prolonged interval sends an applicant into nursing home care when the home setting would have been more appropriate, less expensive, and more rewarding for the applicant.

Our bill will expedite and equalize the process, providing greater access to in-home care by extending “deemed 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.

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.

This program does not call for additional Medicaid funding and does not change the low-income criteria to become eligible, nor will it alter or lower standards of care or eligibility. Instead, it enables our loved ones to receive in-home care more swiftly.

This bill was Senate Bill 912, which passed the Senate last session by a vote of 48 to 0. Additional cosponsors included Senators Baker, Brewster, Browne, Costa, Greenleaf, Haywood, Hughes, Leach, Martin, Mensch, Regan, Scavello, Schwank, Tartaglione, Vogel, Vulakovich, Wagner and White.

Please join us in correcting this disparity in deemed eligibility, so that our seniors applying for Medicaid can receive the care they qualify for, in the setting they prefer, in a way that conserves taxpayer resources while honoring their wishes for independence and dignity. Thank you.

Introduced as SB277