FSSA updated their FAQ regarding Structured Family Caregiving (SFC) on June 18, 2024, to clarify who can be paid to provide Home Health Services (HHS) paid through Medicaid Prior Authorization (PA) (non-waiver funding).
The FAQ states, “A waiver recipient can be authorized to receive Structured Family Caregiving and PA for Home Health. The services can be delivered on the same day but cannot be delivered at the same time. In addition, the services cannot be delivered by the same paid caregiver.
FAQ on Structured Family Caregiving &
Prior Authorization Home Health Services
June 18, 2024
Can Prior Authorization (PA) Home Health services and Structured Family Caregiving be provided concurrently to a Medicaid recipient?
Yes. A waiver recipient can be authorized to receive Structured Family Caregiving and PA for Home Health. The services can be delivered on the same day but cannot be delivered at the same time. In addition, the services cannot be delivered by the same paid caregiver.
Can an individual be both the paid principal caregiver of Structured Family Caregiving and paid to provide PA for Home Health services for the same Medicaid recipient?
No. To be eligible for PA for Home Health services (both Nursing and Home Health Aide), an individual’s primary caregiver must be unavailable to provide care for one or more reasons (IHCP Home Health Services module, pg. 3). The primary caregiver cannot be unavailable so that the individual is eligible for PA for Home Health services, while also being paid to deliver those same services.
If I am the paid principal caregiver for a waiver recipient receiving Structured Family Caregiving, can another member of our household be a Home Health Aide for them, assuming they are qualified to do so?
Yes, Structured Family Caregiving and PA for Home Health services can both be authorized as long as they are not provided by the same individual and not provided at the same moment in time.
I was told by my home health provider that I could be paid as a Home Health Aide or Nurse and be the paid caregiver under Structured Family Caregiving. What should I do?
This is incorrect information. If you are providing Structured Family Caregiving, you need to tell your home health provider they need to help you find another home health aide or nurse. If you prefer to be paid to provide PA Home Health services as a Home Health Aide or Nurse, you need to talk with your care manager about alternatives to Structured Family Caregiving.
FSSA will be updating both the IHCP Home Health module and the prior authorization and service plan review processes to reflect this policy.