How Did You Apply For a Home Aide? How Long Did it Take? How Many Hours Do You Get?

Art: Robin Mead

Every state has programs that provide free home attendants to help people with disabilities stay out of nursing homes and in their own homes and communities.

These programs are called different things in different places: “In Home Support Services,” “Home and Community Based Services,” “Medicaid Waivers” or “Medicaid Long Term Care” or something else in your state.

Please join our survey by commenting at the bottom of this page with your state name and anything else you would like to share to help others who are applying. Learn more here: The Self-Advocates Guide to Disability Home Aides

I live in: Pennsylvania

• Approval time: 6 months 
• Hours: 56 hours per week
• Tip: They will not count your spouse’s income.

I live in: Ohio

• Approval time: 2 years
• Hours: Started at 15 hours per week. Now at 45. However, there are staffing shortages of providers, so I am only staffed at 25 right now.

I live in: Virginia

• Approval time: 3 months. 
• Hours: 25 per week
• Update: Increase approved. Now approved for 29 hours.
• Program: CCC+ waiver
• Tip: You can do either agency-directed (they send an aide from an agency) or consumer directed (choose your own aide).

I live in: California

• Approval time: 9 months (It is supposed to be 30 days. They delayed my case and I had to go to court. The workers who were handling my case got fired. When I got approved, I got 9 months of backpay.)
• Hours: 43 per week (130 per month) 
• Program: IHSS

I live in: Oregon

• Approval time: 3 months
• Hours: 25 per week
• Tip: The state qualifies you for care based on certain criteria – for example, falling down inside your home or needing help with bathing and toilet. Once you meet those criteria, then they decide the number of hours you get based on several factors, including how well you can care for your home duties (Shopping, cooking, cleaning, etc)

I live in: Washington State

• Approval time: 30 days (for my son). After approval, I did 20 hours of online training to become his home aide. (I am my son’s home aide)
• Hours: 17 per week.
• Tip: The assessment interviews are very focused on Activities of Daily Living (eating, bathing, moving around the house, making your own food, prepping and taking your own meds, toileting).  Whatever diagnosis you have, you need to relate it to how it impacts your ability to do your daily activities.

I live in: Virginia

• Approval time: One year. I was denied at first and reapplied.
• Hours: 25 at first, then increased to 34
• Program: Elderly or Disabled Consumer Directed Care
• Tip: The Social Worker told me to describe my worst day when I answered the questions. And she said I have to explain any time I need any help with bathing, eating, dressing or bathroom, even if it is small – Like if I can put on my own shirt, but need help for shoes.
• Tip: It’s better to hire someone you know. I begged my sister to take the job, because I did not want to hire a stranger. She does it to help me, even though she is overqualified and could get a job that paid more.

I live in: Tennessee

• Hours:  8 hours per week, plus 100 hours per year. It’s on a person-by-person basis, and every person gets different amount of services.
• Bonus: One meal per day delivered in 2 week boxes (in addition to home aides), some durable medical equipment.
• Tip: After applying: You have to have a yearly home meeting. It’s about 2-3 hours and your caregiver is interviewed about you also. You usually get a caregiver who works through a home health agency, but you can apply to hire your own person instead if you wish.

I live in: California

• Approval time: 2 weeks
• Hours: 57 per week (228 per month) 
• Program: IHSS
• Notes: Took additional time for caregiver to get approved to be a provider, so first check was delayed but went back to date of approval.

I live in: Virginia

• Hours: 25 per week
• Approval time: 4 months
• Tip: I applied by emailing my local Social Services department and asked who I could contact about getting a screening for Medicaid home care. Then a Social Worker and nurse came to my house and asked me a lot of questions. It took about two hours. They were very nice and THEY BELIEVED WHAT I SAID. It was totally different than applying for disability.
• Tip: If you have too much income for Medicaid, you can still qualify for this program.

I live in: Oregon

• Approval time: 1 month
• Hours: 10 per week
• Program: Aging and Disability Services
  
• Tip: Ask for an In-Home Assessment. I applied a year ago, and they denied me by sending me a letter stating that I had “withdrawn” my application without ever visiting my home and evaluating my limitations.
• Tip: If you are over age 55, research Medicaid estate recovery. In some cases, when you die, Medicaid will take the property or savings you may have left.

I live in: New York

• Approval time: 2 months
• Hours: 28 initially. Now 14.
• Program: Medicaid long term care.
• Bonus: Transportation
• Tip: Make sure your doctor really understands your limitations and accurately describes then on her form. If you have an illness like ME, you may have to be prepared to educate the assessment person about the nature of your illness and limitations.
• Tip: If your income is too high for Medicaid, you might still qualify through Medicaid working disabled program.

I live in: Pennsylvania

• Approval time: 3 months
• Hours: 46 per week
• Tip: You need a doctor to say you meet nursing-home care criteria, so you need a doctor to listen to you.
• Tip: You must indicate if you need help with Activities of Daily Living (bathing, dressing, eating, bathroom, mobility)
• Tip: Make sure to tell them if you are at risk for falls. This helps your application. My caseworker writes “assistance as needed and supervision” with every activity, because I need help when my symptoms are bad, plus I am at risk for falls and in the past I fell in the bathroom and broke my leg.

I live in: CALIFORNIA

• PROGRAM NAME: IHSS
• APPROVAL TIME: 2 weeks. During the SSI Financial Interview, the worker asked my disabled daughter if I helped her at home. She told us to apply for IHSS because my daughter already qualified as a Medi-Cal (Medicaid) recipient. We applied by phone; the Social Worker visited home and completed Needs Assessment.
• AFTER APPROVAL: I am now my daughter’s provider. I had to attend IHSS Orientation. Paychecks were backdated to date of application.
• Hours: 12 hours, 9 minutes per week.
• TIP: Because I live with my client (daughter), I do not have to pay Federal or State Income tax on my IHSS paycheck.
• TIP: If your caregiver does any “paramedical” services (infusions, catheterization, etc.) you should prepare Form SOC 321 in advance with your primary care physician. Because I administer IV meds, the Social Worker told us to have her doctor complete Form SOC 321, so that I could be paid for that as well.

I live in: New York

• Approval time: One week to start services in a temporary program. 30 days to get approved for ongoing services. Several months to get ongoing services set up.
  
• Hours: 20 per week
• Program: Long-Term Care Services through Department of Social Services
• Bonus: Other benefits: Home delivered meals, toilet bars, shower seat, other equipment, social worker to come to house to help with paperwork. They re-certify me every six months to see if I still qualify or if changes need to be made.
• Tip: It’s important to be your own health advocate and fight for the services you need.
• Tip: Consider self-directed care. After two years, and dozens of aides (breaking stuff, stealing stuff, causing me stress), we made the decision to go with Consumer Directed Home Care which allowed me to name whomever I wanted as my aide. My daughter took over and now she is my aide.

I live in: Indiana

• Approval time: 6 months to apply + 1 month to start services
• Hours: 15 per week

I live in: Indiana

• Approval time: My family set up a Special Needs Trust so I could qualify financially for Medicaid. It took me a while to get on Medicaid, but once I got Medicaid, it didn’t take all that long to get into the Waiver program.
• Hours: 95 per week
• Program: Indiana Consumer Directed Attendant Care Program
• Bonus: This program also covers assistance in the community, for example visiting family, shopping, attending church, meetings or community activities.
• Bonus: Parents can be providers for adult children, and can live-in if the person’s needs require it.
• Bonus: I select my own Personal Care Attendants. College students make great attendants.
• Tip: Many caseworkers are friendly and want to help you. However, this waiver is not well known so they may not be familiar with it. Read the program documentation carefully and write down your needs in detail.
• Tip: Describe each task you need assistance with, how long it takes and why it takes that long. This will help your case worker to advocate for you to get the hours you need.

I live in: California

• Approval time: 2 weeks.
• After approval: I am the aide for my child so I had to go to orientation and set up pay system. Paychecks back-dated to date of application.
• Hours: 13 hours per week
• Program: IHSS
• Tip: In California, you can google the “IHSS Advocate Manual” It provides a “Needs Self-Assessment” chart which helps when you have your social worker visit. If your caregiver does any “paramedical” services (infusions, catheterization, etc.) you should prepare Form SOC 321 in advance with your PCP.

I live in: Indiana 

• Hours: Currently 0 – stopped using program
• Program: CHOICE (Community and Home Options to Institutional Care for the Elderly and Disabled). This is not a medicaid program. It is a different kind of home aide program provided by the state.
• Tip: Unlike medicaid waivers, this program does not allow you to select your own caregiver (at least in my county), so I had to use an agency. I live in a rural area and eventually was no one available at any of the agencies. When I did have an aide, the program allowed for transportation (in theory). But my experience was that no agency was prepared to meet that need for insurance reasons. An aide could accompany me, but could not drive me.

I live in: Ohio

• Approval time: One year wait list
• Hours: Started with 12 hours per week. Increased to 42. Currently 35. 
• How to apply: A case worker will come to your home to assess your level of need. After assessment, when services are approved, your doctor is sent a summary and asked to agree with the service level the case manager is proposing, or to increase services, or make additional suggestions.
• Tip: Most waiver programs wont approve services unless you require assistance with some aspect of personal care – bathing, washing hair, toileting, eating, ambulating, transferring, etc.
• Tip: I prefer hiring “independent aides” who work for themselves and avoiding Agency staffing, if possible. My current aide is like a good friend. She really cares. She follows the “care plan” and does all kinds of extras to help me continue to live independently.
• Other benefits: home delivered meals (14 per week), medical supplies, emergency response system, a weekly visit from a nurse, transportation to appointments, and a lot of other benefits.

– Submitted by Snowtopia

I live in: Washington State

• Approval time: 3 months
• Hours: 26 per week.
• Program: Applied through Aging and Disability Services.
• Bonus: Parents can be caregiver for adult children. I applied to be caregiver for my son.
• Tip: We had to appeal when they wanted to cut us back to 52 hours. Appeal went through his Social Worker and got approved.

I live in: Washington State

• Hours Example: 10 hours per week for someone needing medication, bathing, and dressing reminders, shower supervision, and a steadying hand to walk when dizzy.
• Hours Example: 90 hours per week for an almost totally paralyzed person needing full dressing, bed and toilet transfers
• Tip: It’s super quick and easy to a caregiver if you ever need help with bathing, dressing, toileting, or taking meds (even if you only need help on bad days). You need to require help in at least one area above.  They will also factor in other things you need help with in the house (cleaning, cooking, shopping, etc).
• Bonus: In some areas there is a new program called New Freedom Waiver. If you don’t use all of your caregiving hours each month, you can get money for the unused hours to use for other health-related expenses.
• Bonus: The people who work for this program are in the practice of believing people. I never felt challenged about the legitimacy of needing help.

I live in: Oklahoma

• Approval time: I had to get determined disabled by the Social Security Administration first (note: Not all home aide programs require this).
• Hours: Started at 8 hours per week. When my health declined, increased to 15 hours.
• Bonus: Home delivered meals, extra prescription drug coverage, home modifications (grab bars, handheld showers, etc), mental health counselor visit in my home once a week.

I live in: Massachusetts

• Approval time: 3 months
• Note: This is not a medicaid program
• Hours: 4 1/2 hours per week, however often without help due to the following issues: not understanding reasonable accommodations for Multiple Chemical Sensitivities, low wages/high turnover of workers, workers not physically able to perform duties, and other issues.
• Program: Massachusetts Rehabilitation Commission (MRC) Home Care Assistance Program (under 60).
• Tip: Western Massachusetts has few agencies contracted with the state willing to accommodate MCS clients. However, I am working with a task force creating new contract rules for accommodations and a free training module to improve conditions for workers and clients.

– Submitted by: Maria Malaguti

I live in: New York

• Approval time: 1 year
• Hours: 63 per week (In theory. In practice it is cut somewhat lately)
• Program: Nursing Home Transition and Diversion Medicaid waiver program in New York.
• Bonus: Rental subsidies and environmental modifications (e.g. wheelchair ramps)
• Tip: he program goal is to get people out of nursing homes, but they can also help keep you out of a nursing homes even if you’ve never been in one.

I live in: Virginia

• Approval time: 3 months
• Hours: Started at 25. Increased to 30. Then 40. Now 56.
• Program: CCC+
• Tip:  If you apply for utility assistance, and you have a live in caregiver, your caregiver’s income is excluded. The people who work at the department of social services do not know this rule. You have to look up the manual and show it to them.
• Tip: If you live in HUD housing, or you have a housing voucher, your live in caregiver also has their income excluded. They get free rent.

I live in: New York

• Approval time: 2 months
• Hours: I was approved for three days per week, but I requested that I only wanted one day.
• Program: Home aides through medicaid. This was years ago. It may be different now. They sent someone from an agency that did grocery shopping, laundry, and cleaning.

I live in: State Not Disclosed

• Approval time: 4 months
• Hours: 18 per week 
• Tip: Watch out when you call and ask about this program. They will tell you that you cannot apply or you are not eligible, even when it is not true. I have a friend who called for three years and every time she was told she was not eligible. Finally, they sent a nurse to her house for a screening, and she got approved.

I live in: Virginia

• Approval time: 3 months
• Hours: 30 per week
• Bonus: Home modifications, assistive technology
• Tip: You have the right to request a home visit for a full screening. If they try to turn you down on the phone, tell them you plan to appeal and insist on getting their decision in writing.
• Tip: If your home aide lives with you, they do not have to pay income tax because of “difficulty of care income tax exclusion.”

I live in: Nebraska

• Approval time: less than 1 week, once they figured out that I should be getting Personal Assistance Services rather than Aged and Disabled Services
• Hours: 24; working on getting more
• Bonus: Home modifications, assistive technology
• Tip: Try to find the form they use to determine time. In my state it was fairly easy to find on the website. Think creatively about the categories- for example, I was able to get daily time for helping with my braces under the “TED hose” category, and for energy budgeting under the “check vitals” category.

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If you are in a waiver program and we would love to hear how you applied, how long it took, and how many hours of care you are getting, and if you have any tips for others applying. Please leave a comment below.