Home and Community Based Services Manual


3.45 Homemaker (Aged and Disabled Waiver)

Homemaker (HC) services are general household tasks for the participant as an alternative to nursing facility care. Homemaker services must be reasonable and necessary according to the condition and functional capacity of the participant.

  • Authorization of HC is funded through the Medicaid Aged and Disabled Waiver (ADW) only. As it is a federal requirement that State Plan services be utilized before authorizing comparable services in a Home and Community Based Waiver, all appropriate State Plan Personal Care (PC), Medically Related Household Tasks must be utilized before the authorization of Homemaker (HC) services to the Person Centered Care Plan (PCCP). An exception to this requirement is for the provision of Home and Community Based (HCB) Medicaid (Medicaid Eligibility). ADW services can be authorized before utilizing comparable State Plan services if the ADW services are being authorized in order for the participant to qualify for HCB Medicaid or a Miller Trust.
  • All HC participants must meet the following eligibility criteria:
  • Participants who are eligible for Medicaid on a spenddown basis may be authorized to receive HC services during periods when they meet their spenddown liability.
  • A participant is responsible for the cost of services received during periods of time when they have not met their spenddown liability.
  • Authorization of HC does meet the requirement for an individual to be eligible for HCB Medicaid.
  • HC services shall not be authorized when the participant lives with other persons who are able to perform these tasks. If necessary, HC may be authorized to perform only those tasksessential for the participant, such as cleaning the participant’s room, changing the participant’s bed linens or cleaning the bathroom after bathing the participant. Any HC services authorized in this type of living arrangement shall not include cleaning common areas used by all members of the household.
  • HC services shall be authorized in 15-minute units.
  • HC units authorized shall be consistent with the HC tasks to be completed on a regular basis.
  • The amount of HC tasks identified shall be reasonable for the amount of HC units authorized.
  • HC shall be included in the overall HCBS Cost Maximums of care for the participant.
  • HC authorized together with other Home and Community Based Services (HCBS) shall not exceed 100% of the average statewide monthly cost for care in a nursing facility, without prior approval of the Bureau of Long Term Services and Supports (BLTSS).
    NOTE: When the care plan includes an authorization for RN services, the cost of one RNvisitshall be excluded from the calculation of a care plan’s cost.
    • When the combination of State Plan and ADW services exceed the 100% cost maximum:
      • The appropriate supervisor for the Division of Senior and Disability Services(DSDS) staff shall review all person centered care plan requests over the 100% cost cap to ensure the participant’s unmet needs require the amount of service requested.
      • If documentation supports the request, the case shall be forwarded to BLTSS for consideration and approval prior to authorization over the 100% of the cost cap.
      • Pending the approval from BLTSS to exceed the cost cap, HC services in combination with other State Plan or ADW services shall be authorized up to the 100% of the cost cap.
  • HC is provided by HCBS providers enrolled as an ADW provider with the Department of Social Services (DSS), Missouri Medicaid Audit and Compliance Unit (MMAC). Payment is made to the HCBS provider on behalf of the participant.
  • The individual providing the homemaker service is an employee of the HCBS provider and cannot be a member of the immediate family of the participant. An immediate family member is defined as a parent; sibling; child by blood, adoption, or marriage (step-child); spouse; grandparent or grandchild.
  • Restrictions:
    • Individuals who reside in a nursing facility, Residential Care Facility (RCF) or Assisted Living Facility (ALF) licensed by DHSS, Division of Regulation and Licensure are not eligible for HC.
    • Participants authorized for certain services though the Department of Mental Health Services (DMH) may not be eligible for services as outlined in this policy. Staff shall refer to the DMH Service Coordination Policy for guidance on coordination of services for participants authorized for DMH services.
    • Participants who receive Medicaid due to eligibility for Blind Pension (BP) are not eligible for HC services. o Participants in a ‘Transfer of Property penalty’ are not eligible for HC services.
    • Participants receiving services through any other HCBS waiver are not eligible for HC services funded through the ADW.
  • Homemaker services may include any of the following tasks:
    NOTE: Suggested times and frequencies have been developed with the care needs of an average or typical participant in mind. In the development of the (PCCP), consideration shall be given regarding the size of the home, geographic location, specific participant limitations, formal and informal supports, and other factors that might affect the amount of time necessary to complete required tasks.
    • Meals/Dishes: Consideration shall be given the participant’s ability to prepare a light meal such as sandwiches, soups, and salads and/or the availability of home-delivered meals. Many participants will not need meal preparation on a daily basis, regardless of the type of meal. Includes washing, drying and putting away participant’s dishes. (Suggested time 10 - 60 minutes – Suggested frequency 1-7 x/week)
    • Clean Kitchen: Includes cleaning counter tops, tabletop, and sweeping and mopping floors. (Suggested time 30 - 45 minutes – Suggested frequency 1x/week)
    • Clean Bath: Includes sweeping and mopping the floor and cleaning the tub, toilet, and sink. (Suggested time 30 - 45 minutes – Suggested frequency 1 x/week)
    • Clean Living Area: Includes sweeping/vacuuming/mopping all floors as necessary and tidying and dusting. (Suggested time 10 - 45 minutes – Suggested frequency 1 x/week)
    • Make Bed/Change Linens: Linens are generally changed once a week and the bed made on days the employee is there. (Suggested time 10 minutes – Suggested frequency as needed)
    • Laundry (Home/Off Site): Includes washing, folding, and putting away clothing. An off- site facility will require additional time for completion. (Suggested time 30 – 150 minutes – Suggested frequency 1 x/week)
    • Iron/Mend: Includes ironing and mending clothing as directed by participant. (Suggestedtime 10 - 15 minutes – Suggested frequency 1 x/week)
    • Wash Windows/Blinds: Includes washing inside windows and cleaning blinds that are within reach without climbing. (Suggested time 10 - 15 minutes – Suggested frequency 1 x/week)
    • Trash: Includes bagging and carrying trash out to receptacle. (Suggested time 5 minutes – Suggested frequency 1 x/week)
    • Shopping/Errands: Includes travel time to and from the store and putting items away upon return to participant’s home. If shopping is required more than once a week, the amount of time should generally be decreased. Shopping does not include going to multiple stores, unless necessary. The store should be a reasonable distance from participant’s home. Essential errands include banking, post office, bill paying, etc. (Suggested time 60 - 120 minutes – Suggested frequency 1-2 x/week)
    • Essential Correspondence: Includes reading/writing essential correspondence for blind, someone who is unable to read or write, or physically impaired participants. (Suggested time 30 minutes – Suggested frequency 1 x/week)

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