Lawmaker seeks payment for family caregivers

Family members or loved ones caring for Missouri's Medicaid patients could qualify for compensation for their caregiving if a bill passes this session.

Rep. Kurt Bahr, R-St. Charles, has filed legislation that would supply stipends to caregivers providing 24-7 assistance to some of the poorest people in the state. The model is called structured family caregiving, and Bahr said it could save the state money by preventing paying for Medicaid patients in nursing homes.

A company hired by the state would oversee the caregivers to ensure clients' needs are met, he added.

Rick Henley, regional director of state and community relations with Seniorlink - a company that offers that oversight, said that the structured family caregiving model fills the gap intermittent personal care and institutional services, such as an assisted living or nursing home facility. It also utilizes an agency to employ a nurse and a care manager to supervise each caregiver and client.

"Normally, by the time somebody needs around-the-clock supervision, it's only going to be a family member or someone who's very close to the (client) and is going to step up and take on that full-time commitment," he said.

Concerns over Medicaid fraud can be muffled by requiring a caregiver to submit daily electronic notes and monthly visits, he said.

Nikki Strong, executive vice president of the Missouri Health Care Association, said that's not enough to keep caregivers accountable.

"I don't see the mechanisms in place from keeping the fraud from happening," she said.

Many questions surround the bill, Strong added, such as: What will be the cost to the Medicaid program? Will it save the state money? How will it be regulated?

For seniors, this potential program could be another health care option, said Mary Schantz, executive director of the Missouri Alliance for Home Care. Missouri seniors have two choices currently, she said. Consumer-directed services allow the clients to determine all aspects of their care and in-home providers work for an agency who give care based on a plan by the state.

"It's nice for seniors and their families to have a lot of options to choose other than residential care or nursing home facilities," Schantz said. "I think it's a positive that this is a potential new option for us."

Scott Penman, with the Missouri Council for In-Home Services, said the organization generally supports the expansion of family and community programs, but would like the program management determined by statute, not rules and regulations. He said caregiver background checks should be required and caregivers should fill out the same application needed for the Family Care Safety Registry through the Department of Health and Senior Services.

"It's always a fine balance between putting things in statute versus allowing agencies to create things by rule," Bahr said. "You have to put enough in statute so that the rules are crafted to achieve the program desired without inadvertently allowing or preventing something that is beneficial or not beneficial."