Joni is a retired mental health professional and realtor; a mother and a grandmother. She lives in a rent-assisted apartment for older adults in Fargo. Her current income is $1,344 per month, which includes $974 from Social Security and $370 from alimony, but this source is unpredictable.
Joni has multiple, chronic medical conditions and a limited income so, she has to prioritize her very costly medications, health insurance premiums and prescription insurance expenses. Even having access to rent-assisted housing, she constantly struggles to pay her monthly expenses, one of which is a 14 year-old vehicle which helps her remain independent, and allows her social opportunities, especially because having a vehicle facilitates visits to her grandchildren. Despite her income challenges, she has limited assets which are enough to disqualify her from Medicaid eligibility.
Joni needs 2-4 hours per week of Homemaking Services at a cost of $201-$402 per month to maintain her independence.
Based on her current income, Joni could qualify for Service Payments for the Elderly and Disabled (SPED). The sliding fee scale would allow her a 40% discount on the cost of Home & Community Based Services. This means that she would be responsible to pay for 60% of the cost. To meet her current need of 2-4 hours of homemaking a week, she would be responsible to pay out-of-pocket approximately $120-$240 per month. While this doesn’t sound like a lot, these dollars would have to come from an already over-stretched budget so, she had to make the decision to go without.
Over time, not having access to services means that Joni will not be able to maintain upkeep in her apartment or she may risk potential injury by completing the chores herself. This can be a trigger for further deterioration of her medical conditions, thus resulting in a need for a higher level of care.
House Bill 1032 will reduce or even eliminate Joni’s out of pocket costs for HCBS- homemaking services and allow her to continue to live independently in her home and community.
Delivering just the right level of service to people when and where they need it, and when and where that service has the most opportunity to do the most good, is an optimal approach to service delivery. But as we all know, that can only work if people can afford to access the services they need.