How To Make Sure Caregivers Get Paid On Time

Allison Pierce
Participant Liaison

I have the privilege of serving as the iLIFE Participant Liaison in northeastern Wisconsin.  Participant Liaisons serve consumers in IRIS, Wisconsin’s self-directed supports program.  We help consumers in a number of ways, from helping solve payment problems, to getting set up on the iLIFE Portal, our electronic time report system.  Being able to serve consumers in the regions they live in allows each Participant Liaison the opportunity to form relationships and understand some of the unique challenges and situations that consumers face.

A common trend that Participant Liaisons see across the board is that caregivers may not always receive their mailed paper checks on pay day.  We end up with a high call volume and often confirm that checks have been cut and mailed out, but since we have no way of tracking things through the postal service, we cannot guarantee an exact date that checks will arrive.

The best way for caregivers and employers to guarantee that payments are received on pay day is signing up for direct deposit.  This ensures that money goes directly to the caregiver’s account on pay day, while the check stub may still arrive in the mail a day or two later.

 

It’s understandable that sharing back account information is not for everyone.  But, there are options for direct deposit without a home bank.  Companies like Visa and MasterCard offer re-loadable money cards/debit cards through places like Walmart that act like a bank debit card (cards available for a small upfront fee and with small monthly service fees).

Encourage the consumers you serve to sign up for direct deposit!  There are many stresses on consumers.  Direct deposit takes away the worry of wondering when a paycheck will arrive.  Setting up auto-payment through direct deposit helps get caregivers paid timely and accurately and helps long-term care programs run more efficiently.

Learn more at iLIFEfms.com.

What the Americans with Disabilities Act Means 25 Years Later

April Bautista
Participant Engagement Coordinator

The Americans with Disabilities Act (ADA) was signed into law in 1990. At the time, the ADA was the world’s first comprehensive civil rights law prohibiting discrimination in employment, transportation, and public programs based on disabilities. This year, the ADA celebrates its 25^th anniversary…and there is a lot to celebrate!

The Legacy of the ADA

Because of the ADA, people with disabilities enjoy the benefits of wheelchair ramps and lifts on buses, accessible bathrooms, and books offered in Braille at public libraries. Universal design is now the “gold standard” in retail product development and architecture. Assistive technologies and devices that increase capabilities of people with disabilities have made it easier than ever to fully participate in society.

   

However, there are significant shortcomings. Despite major strides, the employment rate for people with disabilities is 17.6%. Barriers to accessibility persist in areas like voting and education, and discrimination and bullying are still rampant problems.

The ADA: The Next 25 Years

Despite these obstacles, I remain optimistic. The last 25 years have empowered a new generation of activists who have lived their entire lives during the ADA era. Many Americans have grown up believing that central to the ADA is the notion that every human has the right to be free. It is my belief that we will not only continue to hold businesses, lawmakers, and society at-large to the highest possible standard in upholding the tenets of the ADA but also strive to broaden its scope over the next 25 years and beyond.

We use the infographic below as a training tool for internal education about the history of disability rights. We also share it with consumers and the people we serve to celebrate the ADA anniversary and the work that remains.

Please share this infographic and think about how your organization can support people with disabilities for the next 25 years and beyond.

What is a Medicaid Waiver?

Amanda Cavanagh
Director, Research & Business Development


What is a Medicaid waiver?
Home and Community Based Services are available through waiver programs.  Centers for Medicare and Medicaid (CMS) allows states to “waive” certain Medicaid requirements and pay for home and community based services as an alternative to institutions, nursing homes or hospitalization.  These Medicaid waivers help provide services and to allow people to receive long-term care in the community and in their homes.  Waivers are also ways states can test new or existing ways to deliver and pay for health care services in Medicaid and the Children's Health Insurance Program (CHIP).


Types of Medicaid waivers
There are four primary types of waivers and demonstration projects:

1. Section 1115 Research & Demonstration Projects: States can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP.
2. Section 1915(b) Managed Care Waivers: States can apply for waivers to provide services through managed care delivery systems or otherwise limit people's choice of providers.
3. Section 1915(c) Home and Community-Based Services Waivers: States can apply for waivers to provide long-term care services in home and community settings rather than institutional settings.
4. Concurrent Section 1915(b) and 1915(c) Waivers: States can apply to simultaneously implement two types of waivers to provide a continuum of services to the elderly and people with disabilities, as long as all Federal requirements for both programs are met.

Medicaid HCBS can be provided as part of state-plan services or through waivers. State plan HCBS include mandatory services (all states must offer them), and optional services (offered at state discretion). Whether the services are mandatory or optional, if they are provided under the state plan, they must be offered to all eligible individuals. Services provided under waivers may be restricted to specific groups based on geographic region, income, or type of disability. Waivers may include a wider range of service types than can be provided under state plans. Individuals may receive both state plan and waiver services.


How iLIFE supports Medicaid waiver programs
iLIFE offers a full range of financial services to support federal and state Medicaid Waiver programs.  iLIFE helps people in Medicaid Waiver programs by: 

• guiding employers through the hiring process.
• ensuring workers are qualified caregivers.
• receiving time reports.
• issuing payments.
• handling tax responsibilities.
• detecting and preventing fraud and abuse.

References:
http://medicaidwaiver.org
http://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/waivers.html
http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/hcbsfindings/hcbsfind3.html

Employing People With Developmental Disabilities

Gerianne Prom

VP, Long Term Care Services

March is Developmental Disabilities Awareness Month. This, as well as the celebration for the 25th anniversary of the Americans with Disabilities Act all year long reminds me that we have made a lot of progress.  But, there is always more to do.

These reports from National Core Indicators show the percentage of people with developmental disabilities who have paying jobs in their community.

Of the 26 states surveyed, the average is just 15%. Wisconsin’s average is slightly higher at 22%.  North Carolina sits at 12%.  This data shows that we need to do better and must continue helping people with developmental disabilities live and work in their community.

NCI has a great collection of searchable data at nationalcoreindicators.org.

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Employer Authority: Clear Expectations

Danielle Skenadore

Human Services Manager

Last month, I had the great opportunity to present “Who’s the Boss: Transition Age Youth and Employer Authority” at the 2015 Wisconsin Transition Conference in Wisconsin Dells.  The conference is a chance for educators, professionals, families, and transition age youth to come together and share best practices.  The conference opened up many fascinating discussions about community-based employment, higher education, adaptive technology, home and community-based services, and self-determination.

In both “Who’s the Boss” and many other sessions at the conference, I found myself reflecting on a common theme: expectations.  How do we understand the expectations of the individuals and families we serve?  We often talk about what individuals and families can or should expect from their educators or their employers, but we don’t always discuss what young people can or should expect from their caregivers. 

Clarifying expectations is crucial to successful employer authority.  In my recent post, I highlighted how self-directed programs allow participants decision-making authority in recruiting, hiring, training, and supervising caregivers of their choice.  When a participant or member chooses to exercise this employer authority, they take on the role of a boss. 

Participants and members frequently hire “inside sources” (people they already know) to be their caregivers.  While you might not think interviewing a parent, spouse, sibling or friend is necessary, establishing clear expectations is very important.  When I am out in the community and talking to folks, this issue comes up again and again.

Making sure both the caregiver and care recipient are on the same page from the beginning can facilitate a healthy caregiving relationship.   Check out the slide below for some tips on establishing clear expectations with family or friends. 

To see the entire presentation, please contact me and connect with iLIFE on LinkedIn and Twitter.

Filling in the Blanks of Managed Care

Amanda Cavanagh

Director, Research and Business Development

I have a background in healthcare and technology so I am accustomed to acronyms, industry terms, and catchphrases.  “If you know one ______, then you know only one ______” gets a lot of mileage. I have heard this expression used in a wide array of settings to convey complexity and uniqueness. My question is how does it translate into managed care?

I recently attended the Medicaid Managed Care conference hosted by World Congress in Washington D.C.  This event brings together an impressive group of leaders from managed care, long term care, CMS, state and Medicaid organizations.  Each leader brings a unique perspective, industry expertise, and desire to collaborate for the benefit of the individuals served.

A managed care model is utilized to finance and deliver healthcare to primary and acute patient populations. The goal of a managed care organization is to improve the quality of patient care while simultaneously reducing the cost of health benefits. 

Medicaid managed care leaders emphasize that the incorporation of stakeholder engagement is essential to the development of an integrated Managed Long Term Services and Supports (MLTSS) program. The design of an MLTSS program seeks to uncover how managed care can be sensitive to the unique needs of a given population in a delivery model where streamlined supports are services are the goal.

As managed care continues to influence the development of MLTSS, the catchphrases we use to convey importance can be revisited, analyzed and, ultimately, challenged. If you know one patient do you only know one patient? Yes. But knowing one patient does not mean you only know one MLTSS consumer. Further, knowing one patient does not mean you know the entire market.

In other words, the goal when filling in the blanks should not be “one word fits all”.  We must recognize how words can elevate individuals and their uniqueness and complexity when redesigning models of care.

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Person Centered, Person Driven: Key to the Success of MLTSS

Gerianne Prom
VP, Long Term Care Services

Over 10 Million Americans with disabilities use Long-Term Services and Supports (LTSS) to assist in their self-care, engage in their community, and achieve their goals of living independently. 

Medicaid is the primary funding source for most people receiving services. Each state has its’ own pathway for people to access LTSS.  With increasing frequency, states are moving to Managed Care models.

The movement towards Managed Care is driven by the need to contain costs, ensure quality, and mitigate risk.  Keeping enrollees central to the focus ensures that a quality management system will meet the unique needs of the population being served.  Consumer engagement initiatives also allow for the understanding of quality from the perspective of the people who are being served.

Managed Care programs have long served people with disabilities.  One such Managed Care program in Wisconsin is Family Care. Family Care enrollees have moved back into the community safely after spending years living in institutions, while other enrollees have achieved new levels of independence by living and working in their communities. Most enrollees can boast vast improvements in overall health. These successes are achieved by two principles that are the hallmarks of Family Care: person-centered planning and disability services expertise.

We are at a unique juncture: paralleling the movement towards Managed Care has been the growth and popularity of Participant Directed Programs.  It strikes me that bridging two key aspects—person-centered planning and quality management—might result in a delivery system with improved results. 

I look forward to working on just that.

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Employer Authority

Danielle Skenadore
Human Services Manager

The Wisconsin Transition Conference is an annual opportunity for educators, professionals, families, and transition age youth to come together to share best practices. I have the wonderful opportunity to present “Who’s the Boss: Transition Age Youth and Employer Authority” at the 2015 Wisconsin Transition Conference in the Wisconsin Dells.

What is Employer Authority?

In a self-directed program, participants or members are granted the decision-making authority to recruit, hire, train, and supervise caregivers of their choice. The participant or member is the boss!

Why is Employer Authority so Important?

When we think about transition age youth, most of our discussions focus on community-based employment, independent living, and higher education. But for many, success in these arenas is directly connected to reliable caregiving. 

Young adults who choose to self-direct their supports take on a big responsibility.  Case managers and consultants can provide some guidance, but the real work lies with the individual or family.  

Educators, parents, and professionals must acknowledge the learning curve that exists and encourage young people to develop their Employer Authority skills early on by discussing things like personal care needs, caregiver preferences, activity schedules, and job descriptions. 

I am very excited to work together with young people, families, and educators to identify the tool kit, skills and support that will empower success in a self-directed program. 

Check out the slide below for a sneak peak of my presentation. 

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Embracing Technology

Todd Breaker

iLIFE Participant Liaison

Confusing.  Exhausting.  Time-consuming.

For people that self-direct their support services, paperwork and administrative duties can bring out these feelings.  However, there is another solution.  Technology offers quick and accurate ways to get these tasks done.

One of the ways iLIFE uses technology to help the people we serve is offering online timesheets.  Caregivers submit their timesheets online for approval by their participant employer.  Caregivers get paid timely and accurately without having to fax, mail, or email paperwork.

Sounds easy, right?

When I tell people about this resource, the common response I get is that they are not good with computers.  These are sincere feelings from our participants that I always respect.  The reality is they face other barriers to technology, as well, including limited internet access, high costs for home internet service, or not owning a computer.

Despite these hurdles, there are also success stories.  One example is from a caregiver that had issues with time cards every month.  After they and their employer signed up for online timesheets, this person came to my office and thanked me.  This tech tool helped make their life easier.

I have heard from many participants that self-direct and use online timesheets who never want to see a paper time card ever again. Embracing technology can help participants and their caregivers achieve success through self-directing programs.

So, how can we encourage people to start using technology?  Start a conversation with the people you serve.  Teach, listen, and learn.  It is important to keep in mind we have to offer many different options and allow people to use the methods that work best for them.

Because ultimately, as financial management service providers, we want these emotions to come through:

Timely. Accurate. Trusted.

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Building Better Caregiver Relationships

Matt Queen
Communications Manager

As I meet with people that receive long-term care services and supports, I am shocked to hear the number of people that say they do not get along with their caregiver.

Sometimes it is a family member or a friend.  Other times it is somebody they hired from an agency or found in their community.

Part of what we do at iLIFE is educating people about what they should expect from their caregivers.  Employer authority is an emerging topic and an important skill for people who want to self-direct their care. Making expectations clear to caregivers from the start creates a solid foundation for a good working relationship.

In partnership with the Wisconsin Long Term Care Workforce Alliance, we met with two caregivers and their employer to learn more about creating positive relationships.

Our entire three-part film series on caregiver best practices is on the iLIFE YouTube channel.  Share with your colleagues to help improve caregiver relationships.

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Fraud: Identification and Prevention

Casey Wheeler

Fraud Specialist

Fraud is not a victimless crime. Fraud violates all of the taxpayers who support state and federal long-term care programs. We all have the responsibility to look for fraud and protect the integrity of the programs and people we serve.

What is fraud?

Fraud is the wrongful or deceptive intention to make financial or personal gain. With the pressures in today’s society, some people feel that the only way they can make ends meet is to commit an act of fraud. They rationalize their intentions by thinking that they deserve this money and that their actions do not hurt anybody. Once they see an opportunity to commit fraud, they take it. Unfortunately, a single act of fraud often leads to additional violations.  Fraud’s short-term benefits bring serious long-term consequences, including felony charges, large fines and restitution.

What is the most common form of fraud we see?

The most common fraud we currently see is billing for hours that are not worked. How does this work?

• The program participant makes a deal with one of their employees.
• The employee records more hours than they actually worked (if worked at all).
• The employee gives the participant the money resulting from the extra hours being billed.

Sometimes participants think their allocation is their money. It is not. The allocation reflects the amount of services that the participant is able to receive within that given total.

What can we do to prevent fraud?

There are many ways we can help program participants understand fraud.  Within IRIS, the state of Wisconsin’s self-directed care program, care consultants meet with their assigned participants and complete a participant education form. Once the participant has gone over the material and understands it, they sign the form so all parties can be on the same page.

As a financial management services provider, we educate participants about fraud.  Resources like this info-graphic give participants the information and knowledge to successfully self-direct their services.

Looking out for fraud and reporting suspected activity protects people receiving care, supports those providing care, and strengthens the integrity of long-term care programs.

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Resolutions for 2015

Amanda Cavanagh
Director, Research and Business Development

January is a time for New Year’s resolutions.  When I set goals for the coming year, I envision myself on December 31, 2015.  What do I want to look back on and be proud that I accomplished?

I recently met an amazing participant who receives support and services through one of the long-term programs iLIFE serves.  In the past, this individual’s caregivers took advantage of them.  Not only did they have to fit into the caregiver’s schedule, but they also had to deal with workers unwilling to perform specific tasks they needed done. This abuse of power by a caregiver is tragic.

We then talked about resolutions for 2015.  Although this person is striving to overcome poor caregivers in their past, they are determined to reach their goals.

“This year I will be able to live independently in my home.”

“Next year, I hope to be able to leave my home without assistance.”

This individual’s hopes and dreams exceed all limitations they currently face.  Their strength is an inspiration and reminds me that compassion is an essential part of long-term care programs.

Looking back at my first year working for iLIFE, the determination our consumers have to become independent makes me realize the limitless potential for my personal goals.

So, what is my goal for year two?  This year, I will be a champion for the people we serve.  I will start each day by asking myself, “what will I do today to make tomorrow better?”

That is a New Year’s resolution we can all commit to.

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Fraud is illegal!

Matt Queen
Communications Manager

Did you know that one-third of all elder abuse cases involve financial fraud from family members, friends, and caregivers?

Did you also know that most fraud cases go unreported?

Anybody can be a victim of caregiver fraud.  It happens across age, gender, and socioeconomic lines.  Still, fraud is often under-reported.  Why?

• Victims have close ties to the offender(s) and are protective.
• Victims think they are partially to blame.
• Victims can feel ashamed.

Throughout January, iLIFE is highlighting fraud identification and prevention. 

Educating consumers about fraud encourages participants to speak up when taken advantage of.  Knowing the criminal penalties for fraud can also discourage caregivers from abusing their employers.

As a financial management services provider, preventing fraud and protecting consumers is our priority.  Talk about fraud with the people you serve.  Starting the conversation will protect participants, strengthen your services, and maintain the integrity of long-term care programs.

Check out the iLIFE LinkedIn page for an info-graphic we share with consumers to introduce and define fraud.