If you are applying for home care through a Waiver program, you may be asked a bunch of questions. Your answers are VERY important.
Many people downplay their needs when answering questions because they feel shy or embarrassed or because they have not really thought and noticed small kinds of help they need.
When applying for home care, it is very important to be honest and talk about all the help you need. It is also extremely important to think about the questions ahead of time and to talk with your doctor.
Is It Hard to Apply For?
Most people report that applying for home care is much faster and simpler than applying for disability. In some programs there is a waiting list and in some programs you can begin relatively quickly (within a few months).
Many of our readers have found that the Social Workers in these programs are supportive and believe that your symptoms are real. When you tell them you are sick, they believe you! For anyone who has applied for disability, this is a refreshing experience.
However, even if they are really nice to you and really like you, they still have to follow the rules. According to the rules, if you do not meet the criteria for personal care, you will automatically disqualified. It does not matter how sick you are or how poor you are or how bad your problems are. It does not matter if you are literally going to starve to death because you have no way to get groceries.
And it doesn’t matter how nice the caseworkers are. Even if they like you a lot and they are really nice and they really want to help you, they will still deny you. They may be really sad about denying you, but they have no choice.
What is Personal Care?
Household care and personal care are two different things.
🎀 Household care is laundry, shopping, cooking, errands, and cleaning.
🎀 Personal care is bathing, dressing, feeding, mobility, transferring, and toilet.
When you apply, you will only get approved if you need personal care. Once you are approved, your aide can also provide household care.
What Kind of Care Qualifies?
The rules are different in each state:
🎀 If you need daily assistance with all areas of personal care you will qualify.
🎀 If you need assistance in some areas of personal care (but not all) you may or may not qualify.
🎀 If you need assistance with personal care sometimes (but not always) may or may not qualify.
🎀 If you need partial assistance with personal care, but not complete assistance (for example, you can bathe yourself, but need assistance to get in and out of the bath), you may or may not qualify.
🎀 If you need assistance with just household care you will not qualify.
If you need household care, plus partial or intermittent personal care, be sure to still let them know. Most programs are not designed to give 24-hour care, so if you only need partial care, make sure to tell them your situation, as there is a chance you may still be able to qualify.
California Exception: In California, there is an excellent program called In Home Support Services that may be able to provide you with a home aide even if you do not need personal care and only need help with household tasks.
What if I’m too Sick to Answer Questions?
Someone else can do the interview for you. For example, a parent or a caregiver can answer the questions for you.
What if I Can’t Leave My House?
You do not have to. The assessment is done over the phone, or they will send someone to visit you in your home.
What if Someone Tells Me I Don’t Qualify?
Never ever (ever ever ever) take no for an answer over the phone. We cannot begin to tell you how many people were told “no” when it was not true. Always request the decision in writing and ask how you can appeal.
Waiver programs are run through Medicaid. Many people think they will not qualify because they have too much money for Medicaid. This is often not true. If you think you will not qualify financially, please look here: How to Apply for a Medicaid Waiver When You Have Too Much Money
Talking About Personal Care
If you need partial assistance in personal care, or assistance only some of the time, be sure to let them know. In some cases, you will still be able to qualify.
Many people get turned down for waiver programs, or have to apply more than once because they answer the questions about personal care too quickly, or because they do not meet with their doctor first to talk about all their personal care needs. It’s very important to let them know any kind of assistance you need in the areas listed below.
If you are getting help now, you can describe the help you are getting. If you are not getting any help now, describe the kind of help you need and any problems you are having because you don’t have this help. Areas to think about:
🎀 Bathing – Do you ever need: help getting in and out of bath, help washing your hair, help brushing your teeth, help washing your face, someone to monitor you in and out of shower for safety because you have had falls. If you need any kind of assistance of any kind at any time, it’s very important to let them know.
🎀 Dressing -Do you ever need: help with buttons or zippers, help with socks and shoes, help with coats and sweaters. Laundry does not count. You must let them know if there is any way you need help with the act of dressing. After you are approved, you may be able to get help with laundry, but you will not qualify based on these needs.
🎀 Mobility – Do you ever need: Someone to push a wheelchair, someone to help you transfer in and out of a wheelchair or mobility scooter, someone to walk next to you for balance and safety, someone to bring you or hand you your cane or devices if you drop them. If you need any kind of assistance of any kind at any time, it’s very important to let them know.
🎀 Feeding / Eating – Do you ever need: someone to hold forks or spoons, someone to pick up silverware if you drop it, someone to lift glasses or water bottles so you can drink, someone to cut food, someone to open cartons and pour drinks. Shopping and cooking does not count. You must let them know if there is any way you need help with the act of eating. After you are approved, you may be able to get help with shopping and cooking, but you will not qualify based on these needs.
🎀 Toilet – Do you ever need: someone to help you use a bedpan, someone help you use a transfer toilet, someone to help you walk to the bathroom, sit down or stand up on the toilet, someone to help you with your buttons so you can use toilet. Do you ever have accidents or not make it to the toilet in time. If you need any kind of assistance of any kind at any time, it’s very important to let them know.
For more information on each of the above categories take a look at these: Sample Criteria for Applying for Medicaid Home Aides
If someone is helping you now, make sure to answer every question by describing the help you would need IF YOU HAD NO HELP.
🎀 Example #1: Susan’s mom helps her get dressed every morning. When the caseworker asks Susan if she needs help getting dressed, she says, “No” because she doesn’t need any more help. Susan gets denied.
🎀 Example #2: Susan’s mom helps her get dressed every morning. When the caseworker asks Susan if she needs help getting dressed, she says, “Yes. My mom helps me get dressed every morning because I cannot get dressed without help.” Susan gets approved.
Before your interview, it may help a lot if you start making a list of the help you need. For the next week, make a list of every time you need any kind of help at all in any of these areas: feeding, bathing and grooming, dressing, bathroom/toilet, walking/mobility. Even if the help is just a really small thing, you can still make a note of it.
List any way anyone assists you. If no one assists you, then list any way you needed assistance but didn’t get it. For example, if you didn’t not take a bath for a week because there was no one to help you.
This list can help you a lot at the interview. It can be really hard to think/remember all your needs on the spot. If you have a list that will give you some ideas if you are having trouble remembering.
Tips for Questions
🎀 Give a Clear Answer – Keep your answers brief and clear. If you give a long, confusing, rambling answer, there is a greater chance you will be misunderstood. The person who is doing the interview is not going to write down a long story. They are going to check a box. They do not need or want a long story about your life. They need to know what box to check. They are busy. They need to know whether to check “yes” or “no” so they can move to the next question.
🎀 Don’t Say No Unless it is NEVER – If you ever need help in any area, always mention this. If your answer is “sometimes” you can say “Yes, I need that kind of help some of the time” or “I need that when my symptoms are bad” and then briefly explain how and when. If you say no, you may get automatically get disqualified. If you explain help you sometimes need, the Social Worker will consider the situation and may still approve you.
🎀 Describe your worst day – Many of our readers report that their Social Workers and Medicaid workers recommended that they answer questions by describing what it is like for you when your symptoms are bad. If you get stuck: Try starting your sentence with the these words “When my symptoms are bad…..” Here’s an example of How Roselyn Described Her Worst Day
🎀 Talk about help you usually need – This program is not designed for people who need 24 hour care. If you need help sometimes, but not others, let them know. In many states the criteria is what help do you usually need. For example, if you usually need help bathing, but sometimes bathe by yourself, you may still qualify.
🎀 Shopping and Cooking Doesn’t Count as Help with Eating – If they ask you about eating, it does not matter if you tell them you about shopping and cooking. They need to know if you ever need help with the physical act of eating. After you are approved, you may be able to get help with shopping and cooking, but you will not qualify based on these needs.
🎀 Laundry Doesn’t Count as Help with Dressing – If they ask you about dressing, it does not matter if you tell them you about laundry. They need to know if you ever need help with the physical act of getting dressed. After you are approved, you may be able to get help with laundry, but you will not qualify based on these needs.
🎀 The Past Week – In some programs they will look at the help you needed or got in the past seven days and this is how they will decide if you qualify. It’s important to describe any help you got or need. If you got no help, describe any problems you had because of lack of help (for example, not eating, not changing clothes, not bathing, bathroom accidents). If you did not need help and were able to get through your week without problems, they may consider that you do not need help.
🎀 Bathroom Accidents – They may ask you if you have toilet “accidents” (Times when you did not make it to the bathroom in time). If you have had accidents: Be honest. This is HARD, but it is worth it. It is worth being embarrassed for a few minutes, if it means that you will get help you need every day! If you have not had accidents because someone is assisting you: Try answering this question by letting them know the help you are getting and estimating how often you would have accidents if you had no assistance. If you never got or needed any kind of help in this area, just be honest. It is possible you will still qualify, but it depends on your state and the rest of your care needs.
🎀 If You’ve Had Falls – If you have had any history of falls in your home, make sure to mention this when discussing bathing, dressing and bathroom care. A history of falls may mean that they will consider you need supervision in these areas.
🎀 Cognitive Problems – Some programs will take into consideration if someone has cognitive problems, such as problems with behavior and orientation, that means they need supervision or cannot complete daily living tasks on their own. For example, people with Alzheimers, Dementia, or Developmental Disabilities.
Meet With Your Doctor or Medical Provider
In some states, they will have a form for your doctor or nurse to fill out. We cannot stress this enough: You need to talk to your doctor about this form. Your doctor is not a mind-reader. She probably is not going to remember all your personal care needs, unless you are sitting right there with her when she fills out the form. She may also need to examine you so she can determine her medical opinion about your care needs.
If you are homebound or bedridden, and unable to get to a doctor, you can ask the person running the program if they have any ideas for any way they can arrange for a doctor or nurse to visit your home to screen you. Also check out How to Get a Doctor or Nurse to Come to Your House.
Meeting or talking with your doctor is important. We heard from one reader who was on a waiting list for an entire year. When she got to the top of the list, the program sent a form to her doctor. The doctor was very busy and did not remember exactly what help this patient needed. The doctor checked some of the wrong boxes on the form, and the entire application was denied.
What are the Rules?
The criteria is different in different states. Usually, you will need to require help in a certain number of personal care areas.
If you do not know the rules in your state call and ask. “Can you please tell me what the criteria is for someone to get approved for this program?” or “Can you please tell me where I can find the written policy for this?”
Make sure you are are talking directly to the person who handles screening for Medicaid Home Care programs. Many people who work at Medicaid or other agencies will not know the answer to this, and may give you incorrect information.
To learn more, take a look at these: Sample Criteria for Applying for Medicaid Home Aides
When you first call, you may be given a screening over the phone. Depending on your state, this may be brief (ten minutes) or long (an hour or more).
If it is brief, they will probably follow up by having someone come to your home for a longer detailed interview. Before the home visit, it is helpful if you can bring a list of your doctors, contact information for doctors, current medications, current diagnosis, and information on how often you take each medication. This is not required, so if you don’t have all this information together, don’t worry. It will just make things a little easier.
After the personal care questions, they may ask you a long list of other questions. Many of these questions may seem completely useless or irrelevant to you. It is still good if you can answer accurately.
You do not have to say “yes” every time or get everything perfect, just be honest and do the best you can with it. These questions are not as important as personal care questions, but if the questions show you have a lot of problems, you may qualify for more hours or services.
Some applications are reviewed on a “point system”. The more needy, lonely and pathetic you are, the more points you get!
🎀 “How often do you talk to your family?”
🎀 “How often do you feel sad?”
🎀 “Do you have any food allergies?”
🎀 “Do you do any social activities?”
🎀 “Do you have trouble chewing?”
🎀 “How many medications and supplements do you take?”
They may ask you if you have someone you live with who takes care of you and is not paid. For example, a family member. This is a bit of a trick question.
Logically, it seems like if you already have a live-in caregiver you would get less hours, but this is not how it works in some states. Some states offer extra “respite” hours to give your caregiver a break. So, if you have a caregiver, you get more hours to hire a caregiver! Illogical, yet true.
If you are applying for a Medicaid waiver program, you have two options:
- You can ask them to send you a caregiver from an agency
- You can hire your own caregiver (friend, family member, neighbor, etc)
If you choose to hire your own caregiver, you have two options:
- You can handle the paperwork and timesheets yourself. This will take some time and energy, as it can sometimes be confusing to figure out.
- You can find someone else you know to volunteer to do this for you. This person will become your official representative that can sign paperwork and timesheets for you. This person CANNOT be paid as your caregiver.
If you choose to handle the paperwork yourself, you may be asked some questions to make sure you are able to do this. There is no wrong or right way to answer these questions, just use your common sense. Sample questions:
🎀 What will you do if you have a medical emergency?
🎀 What will you do if your caregiver steals from you?
🎀 How will you find a caregiver to hire?
Other Programs You Can Apply For
If you think you will not qualify medically, there is some chance you may be able to find some kind of help through another program. However, Medicaid Waiver home care is a million times better than any other home care program. Look here: How to Get a Caregiver
Medicare also offers Home Care, but it is much less services, and difficult to stay on ongoingly. Medicaid services are much much better and worth pursuing if you need this kind of help.
If You Get Denied
If you get denied, you have a few options:
🎀 You can appeal the decision. Try requesting your file and/or contacting your Social Worker to see what the problem was. If the problem was that your doctor did not accurately fill out the form about your care needs, you may need to work more closely with your doctor to make sure this form gets filled out correctly. Your decision letter should tell you how to go about filing an appeal.
🎀 You can apply again. If time passes and your condition worsens, or if you feel that you did not answer the questions with enough detail and information, you can request a new assessment interview. Talk to the Social Worker and ask if there is a length of time you need to wait before you can apply again.
About State Home Care Programs
State home care programs are designed to keep people out of nursing homes and allow them to stay in their communities. Most programs are for people with “nursing home level of need,” though some will provide services to people who are less severe but “at risk” for a nursing home.
While many seniors and children join these programs, people who became disabled or developed chronic illness as adults are usually never told that this kind of help is possible.
State home care programs are often called “Medicaid waivers” “long term care” or “home and community based care.” In California, the most popular program is called IHSS (though there are several other programs in California as well).
These programs are run by Medicaid, but you do not need to be on Medicaid right now to apply. In many states, you can qualify even if you have too much money for Medicaid.
Learn more about how to find programs in your area and how to apply: How To Apply for a Medicaid Waiver.
Success stories. Stories from people in waiver programs, how they applied and how they got approved: How I Got Approved for a Home Aide
Connect with others in waiver programs: Facebook Groups for Medicaid Home Care
Learn more about how others applied and what services they are getting now: How Did You Get Home Care? (Survey Results)
After approval, you will be given the choice to hire a home aide through an agency (they will send someone to your house) or hire the person of your choice (friend, neighbor, family member, etc). Both ways have advantages and disadvantages: How to Decide: Agency Care or Self-Directed Care
If someone tells you that you are not eligible for a waiver, this may not be correct. Many people are told this when it is not true. Make sure you speak directly to a Social Worker who specializes in screening for Medicaid Waivers or Longterm Care (do not apply for regular Medicaid). If you are still told no, ask for the decision in writing and ask how you can appeal. Never let them turn you down over the phone and never let anyone talk you out of applying if you really need the help. How to Respond When You Are Told You Can’t Get Medicaid
Updated March 2018. Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working.