4 Replies Latest reply on May 27, 2015 9:24 PM by jbecky

    Evaluating Medicaid Managed Care Plans

    Chrysalis

      My 93-year-old mother is still living at home alone (which I HATE!). She recently qualified for Florida's Managed Care Long Term Care assistance. Apparently, this program will provide her with quite a lot of assistance to help her remain in her home and will pay for nursing home care if and when that becomes necessary. All of the "helpers" (nursing aids, cleaning ladies, care coordinators, etc) will come from one sub-contracting "managed care company". So now she has to decide which of 5 possible sub-contractors she should choose to provide her services for the next year. Is anyone aware of any organization or web site that rates and evaluates in-home care like this? I'm just terrified that she will get some ding dong low life who will show up late, screw up her medications, talk on the the phone for an hour and leave early (paranoid? me?). Anybody have any ideas?

        • Re: Evaluating Medicaid Managed Care Plans
          JerryD

          Your concerns are real. However, my Mom had such care due to a fall for a number of years while living alone. But Mom had an ability to endear such helpers. She always treated these ladies like daughters. Some returned even after no longer serving Mom just to visit. I wouldn't be surprised if one or two didn't attend her funeral too.

           

          So, be concerned and keep a finger on the pulse of these "professional" relationships, if you can. Try to be involved in the selection of the company providing the service and check them out if you can. Pay attention to what Mom says while speaking to her. Check on her finances that you have access to also. Some things we just can't closely control.    :-)))

          • Re: Evaluating Medicaid Managed Care Plans
            jbecky

            Google the companies, and call the state agency for the elderly to check on complaints.

             

            To check on them while they're working, you might use Web-enabled nanny cams. A friend who uses Drop cameras for home security says they're easy to access remotely. You might even put motion sensitive ones in rooms they're not supposed to go in, such as an office where her financial info is stored.

             

            Also, some companies have policies that make sure they're really there. The one I like best is where the aide has to call an automated service from your home phone to clock in and clock out.

             

            Good luck.

            • Re: Evaluating Medicaid Managed Care Plans
              Chrysalis

              Thank you for your suggestions. My mother is a very nice old lady and all of her caretakers, including those at the hospital as well as those at home, like her a lot. That is a good sign. And the idea of a nanny cam is good, too. At the moment my mother can and will speak up about problems, but if I ever start to worry, I will install nanny cams.

               

              I did finally solve my problem. What I was asking about was the 5 big companies that "administer" the managed care in Mom's county. I put "administer" in quotes because they do absolutely nothing except collect a lot of money from the state government for being the middlemen. They probably kick back a lot to the legislators in terms of lobbying and PAC contributions, but I won't go there. These are big companies like United Healthcare, Centene, Humana, etc. The patient (called a "member") chooses their big company and then the big company finds and sub-contracts to small, local companies that actually provide the nurses, caretakers, house cleaners, etc.

               

              So after beating my head for a while trying to determine whether Centene or United or another would be better, I turned the problem upside down. I decided to first identify the small, local company that I wanted to provide personal care services to my mother and ask them which big healthcare companies (if any) they subcontracted with. That approach worked well.

               

              Unfortunately, my mother doesn't know anyone in her area who has this Florida Long Term Care program (it's only 2 years old). But I did find 4 local personal care companies that are accredited by The Joint Commission (see: About The Joint Commission | Joint Commission). I'm not even sure what is required to get accredited but since there are 50 such personal care companies within a 10 mile radius of Mom and only 4 are accredited, that sounded good to me. I called and talked to all 4 companies. Two of them subcontracted with one or more large healthcare companies for the LTC program. I got references from those 2 and chose the one with more years of experience. Then I signed up with the large healthcare company that partners with this local company and said, "Big company, I want you to hire this small company to provide services to my mother." (It is her right to ask for a specific provider.)

               

              So that is how I evaluated Medicaid Managed Care companies-- start with finding the right people to provide the services you need and work backwards to figure out how to hire them.