Streamlining the path to home and community-based care in Pennsylvania

Michael Martin understands urgency. Too often he has heard concern in the voice of callers because of the length of time it took to get the services and supports they needed to remain safely in their homes. For 10 years, Martin has been leading operations of the Pennsylvania Independent Enrollment Broker call center for people seeking Medicaid-funded home and community-based care, as well as long-term services and supports.

He recalls one couple who had been waiting several weeks to complete a necessary component of a Medicaid waiver application for home and community-based services. They were frustrated and anxious. The longer the waiver application process took and the longer they waited to get home care services in place, the more they feared they would need to move into a nursing home.

Situation

The AARP reports[1] that more than 75 percent of adults age 50 and older want to remain in their homes and communities as they age.

Many states are rebalancing from institutional care to home and community-based services as a way to effectively provide high quality, cost-efficient care to populations who require ongoing assistance, including aging individuals and people with disabilities. Nationally, spending[2] on home and community-based services surpassed spending on institutional care for the first time in 2013 and by 2020 spending on home and community-based services reached over 62 percent of total long term care spending.

Challenge

In Pennsylvania, the shift to more home and community-based options required a thoughtful approach to helping individuals navigate the extensive Medicaid waiver application process. In 2016, the state expanded its independent enrollment broker program to support seniors and people with disabilities served by waivers[3] that, depending on an individual’s needs and situation, offer an array of services and benefits. This includes personal care services and supervision, home health aides, medical supplies and equipment, counseling services, support and case management, and a choice of qualified providers.

The state has allocated significant resources toward aging-in-place solutions and helping people with disabilities remain in the community — and Maximus was ready to help the state simplify, accelerate, and improve the waiver application process.

The Pennsylvania Independent Enrollment Broker website[4], created by Maximus, streamlined service provision, reduced waiting times for benefits delivery, and ensured all information is easy to comprehend. Drawing on our digital government expertise, we combined two websites into one central point of access, improving the way beneficiaries interact with their long-term services and supports and community programs. This easy-to-navigate, accessible, and secure website won both a Digital Health Award and a Platinum Hermes Award for transforming how we support aging adults and individuals with disabilities.

Our coordinated approach has helped dramatically shorten the waiver application process from 90 days to approximately 26 days. Now, applicants can work with a number of key stakeholders to ensure their services, which may include service coordination to assess needs such as, in-home modifications or therapies, help with activities of daily life, transportation, and more.

The comprehensive training program we provide to our staff gives them the knowledge needed to support the specific needs of people in a wide range of circumstances. And the visibility that comes with tracking metrics along the way has helped us quickly identify backlogs, such as Medicaid physician certifications, then work to eliminate them.

Results

The Maximus Difference

While technology, quality systems, and training are hallmarks of how we strive to improve an applicant experience, empathy and compassion are also very much part of the process. We see the impact of treating people with dignity and respect: our monthly survey of approximately 6,500 waiver applicants consistently shows that 98 percent are happy with their experience and would recommend the process to a friend.

Thanks to the partnership between the State of Pennsylvania and Maximus, Martin was able to help the worried couple successfully complete the application process and get a home care plan in place.

“We listen, validate what they're saying, and validate their feelings in that moment in time,” says Martin. “Every single person and their circumstance matter to us, and I was so happy to be able to help this couple get the services they desired and needed.”

[1]https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html

[2]Medicaid Home & Community-Based Services: People Served and Spending During COVID-19 - Issue Brief - 9892 | KFF

[3]Support Service Waivers (pa.gov)

[4]PA Independent Enrollment Broker (PA IEB) Home Page