Adult Home Help Services
Home Help Services
Adult Home Help Services (“AHHS”) are those characterized as unskilled and non-specialized activities, including personal care, essential to the care of the client and maintenance of the home. AHHS assists aged, blind, disabled and other functionally-limited individuals with necessary daily activities, which they cannot perform without assistance. The goal of this service is to maintain the recipient in his/her home and avoid a placement into an alternative care facility, that is, a nursing home or adult foster care arrangement. This goal is accomplished by identifying the client’s natural support system and strengthening it whenever possible.
Who is Eligible?
The individual needing services must have MEDICAID eligibility, require home help personal care, and must be living in an unlicensed setting.
What Services are Available?
* (A copy of the “Definitions & Rankings” of each ADL and IADL and a more detailed explanation of the AHHS program is available by calling The Arc of Oakland County office at: 248-816-1900)
Activities of Daily Living (ADL)
such as Eating and feeding, Toileting, Bathing, Grooming, Dressing, Transferring and Mobility. Exceptions to these seven ADL’s are possible only for those with “complex care needs.” The local DHS office is not allowed to grant any exceptions. An appeal must be made through your local DHS Adult Services Worker to the Michigan Department of Community Health’s Long-Term Care Systems Development Section in Lansing, Michigan.
Instrumental Activities of Daily Living (IADL)
- Taking medication.
- Meal preparation and clean-up [maximum 25 hours allowed each month].
- Shopping and for food and other necessities of daily living [maximum 5 hours allowed each month].
- Laundry [maximum 7 hours allowed each month].
- Housework [maximum 6 hours allowed each month].
What Adult Home Health Care does NOT Include
- Supervision, teaching or therapy.
- Medical services.
- Professional contracting or repair services that require services be performed by a certified or licensed provider (i.e., an electrical wiring repair, which requires an electrician).
- Public transportation (e.g., buses, cabs, subways, etc.).
- Transporting for medical reasons (e.g., visits to doctors, pharmacies, hospitals).
- Activities normally performed by other members of the residential unit or family without charge.
- Services provided to persons other than the client. If a provider performs activities for other persons, AHHS may be authorized only for that portion of the service time and cost that is attributable to services rendered specifically to, or for, the client (e.g., meal preparation, shopping, and/or general household cleaning).
Who Provides These Services?
Individuals choose their own providers from available persons, or public or private agencies. All providers must meet minimum qualification requirements and complete a monthly listing of services rendered to the client. Providers cannot be a ”Responsible Relative,” that is, a spouse or dependent child under the age of 18.
How Much is Paid for These Services?
Based on an evaluation of specific services needed, time required, and special circumstances, payment is negotiated between the client and provider. The AHHS “maximum” benefit that a local DHS worker can agree to is $549 or less; the local office DHS supervisor can authorize $1299 or less; all amounts in excess of $1300 must be approved through the DHS main office in Lansing.
Home Help payment rates vary by county – Medical Services Administration Bulletin 09-59 dated, 12/31/2009. The most recent rates are effective 11/1/2009 (see download below for more information on rates).
The possibility exists to receive the higher payment level of AHHS, but only in very special cases. This benefit is called an “exception to home help services.” This occurs in all requests that exceed $549 per month. These “exceptions” are essentially for situations where the functional limitations of the person are “so severe” that $549 will not allow for the provision of the necessary assistance to maintain someone in his/her own home. In other words, the person’s care requirements far exceed the regular, normal levels. Again, this higher payment level is not for general nursing services or supervision. Such “exception” claims must be processed by a DHS worker within 45 days of the request. If an exception is denied, there is an administrative law appeals procedure.
How is Payment Made?
AHHS payment is made jointly to the client and provider and mailed directly to the client. The payment is received the first week after the completion of the previous month following the provision of services.
Are These Benefits Taxable?
Yes! This is taxable income to all providers of services, even parents. However, parents may not be liable for the FICA (“Social Security Tax”) payments. Starting with calendar year 2010, IRS form-1099’s will be issued to all entities not receiving a W-2, which would include parents and some agency providers. A parent may choose to have FICA withheld from the check by notifying their DHS Adult Services worker of this request; the system is not
setup to automatically withhold FICA from a parent.How are Services Obtained ?
Application is made through the local county DHS office. A worker contacts the individual, [REMEMBER, the consumer must have already established MEDICAID eligibility], and conducts a thorough client needs assessment using the current 1-5 scale.
Next, the DHS worker develops a services plan jointly with the client, assists with locating providers, and authorizes services as appropriate. Next, the DHS worker develops a service plan jointly with the consumer, assists with locating providers, and authorizes services as appropriate. A physician certification (form DHS-54A) is required documenting the consumer’s need for services. Only in an “Expanded Home Help” case involving “complex care” or where the payment will exceed $1300 is there also a review by a registered nurse from the Department of Community Health.
Before applying for AHHS it is suggested that the client or client’s family thoroughly review the ADL/IADL definitions and ranks, along with the worksheet scale. Please note that rankings of “1? or “2? will most likely NOT result in any AHHS benefit, since a person in either of those two levels is fairly independent. Keep a diary of daily services provided and also list services that are provided on an irregular basis — as long as such services are covered under the Adult Home Help program.
This advanced planning can prove quite useful when the DHS services worker visits the home to do the “needs assessment.” If asked, providers should indicate that they expect the minimum established rate in their county for the work they do — more if a special skill or task is involved short of a certification or license.
Finally, the DHS worker may ask a family if they would provide or continue to provide services if they were not paid. Families need to know that if they answer in the affirmative (i.e., “Yes”), the DHS probably will not pay for the AHHS even though the client is clearly eligible. So, families who wish to receive compensation for this valuable and important work should tell the DHS worker (if they are asked) that they cannot continue services without compensation.
Home Help Services for Minor Children
The same type of funding is available for children if the following conditions exist:
The child must not qualify for the Children’s Waiver Program. If a child in need of services is a recipient of SSI or MEDICAID, there is no income test for the responsible relative(s). The child is automatically eligible.
Payment can only be authorized for personal care services, not for supervision. The child’s condition must be such that care requirements exceed the “age-appropriate” demands that would normally be placed on the parent(s). An example of this would be: changing diapers for an infant is considered an age-appropriate responsibility of parents, but changing diapers for a 10-year-old with a disability is personal care under this
Parents cannot be personal care providers. Siblings, however, can be providers; also, grandparents, and so on. If the need for specific Adult Home Help care services is based on the parent’s need to be away from the actual home (e.g., for education and training), then such services can only be authorized during the actual hours that the parent must be away. Remember, AHHS only pays for hands-on care and NOT for supervision time! 5. There are also provisions covering parents who are physically disabled and unable to care for their child. Again, only for hands-on care — supervision is NOT a covered service.