Home care services, including respite care and personal care services, are available through Virginia Medicaid and all major insurance plans (Anthem, Aetna, United Healthcare, Molina Health, Optima Health, and others). The service unit will be one hour long and temporary care services are limited to 480 hours per exempt person per state fiscal year. If an exempt person changes exemption programs, the same maximum number of hours of respite care will apply. Payment for additional hours of rest that exceed the maximum limit of 480 will not be approved.
Individuals receiving respite care services under this exemption, both through the agency-led model and the CD model, must not exceed 480 combined hours per state fiscal year. Virginia allows self-direction as part of consumer-facing services (CDs). If a family member wants to provide a break so that an unpaid primary caregiver can take a break, they can hire someone through a CD program instead of an agency. Compared to the more complex and lengthy training requirements for relief service providers hired by an agency, training and responsibilities are established by the exempting participant and are generally less exhaustive in the case of a family member hired for relief service through a CD.
Medicare will generally cover up to five straight days of respite care. However, temporary leave can be used more than once, depending on your loved one's unique circumstances. Medicare beneficiaries may have to pay for respite care out of pocket. The information obtained from seven case studies and state interviews provides key information about how states are currently providing respite care and offers emerging strategies that other states can replicate.
Self-management programs allow the person receiving care to become an employer and to discretionally hire a professional assistant, or even a family member or friend, as a paid palliative care provider while their primary caregiver takes a break. To expedite access to services, Kentucky hires providers and case managers to certify family caregivers as part of their waiver application process and to defend the value of respite care. Some of the studies indicate that Iowa, Texas and Virginia allow managed care organizations (MCOs) to expand and improve access to and utilization of palliative care services. Self-management programs can integrate family or friends into the formal care system and comfort families when they take a break because someone they know is caring for their loved one.
Respite care services will be limited to 480 hours per person per state fiscal year until authorized. As caregivers are increasingly being asked to provide more intense and complex care, respite care is critical to providing caregivers with much needed rest. Respite care can be offered in hourly increments or on consecutive days, at home or in a facility. You can also search for Medicare providers on the Medicare website or ask your state's Medicaid department for a list of approved local respite care services.
Texas is one of two states that allow their MCOs to add temporary rest services as a value-added benefit for people enrolled in their managed care program. Despite Medicaid's role as a major contributor to long-term services and supports (LTSS), the amount states estimate they will spend on respite care is a small part compared to other exemption services. If the agency-run respite care service is the only service the exempt person receives, they must receive it at least every 30 days. While states use several federal programs to provide foster care services, Medicaid pays the most for long-term care services, including foster care services.
If you're only providing mild assistance to your loved one such as help with cooking and cleaning, and it's safe to leave them alone, you may not need respite care.
