New state law provides more opportunities for disabled to receive at-home care
August 9, 2023
Elders and adults with disabilities will have more opportunities to get care at home or in a home-like setting under a bill that became state law when Gov. Mike Dunleavy signed it on July 29.
The measure, Senate Bill 57, serves two broad categories of Alaskans who might otherwise have to move into assisted-care facilities: disabled adults, including youth who have aged out of the foster system, and elders.
For disabled adults, the bill authorizes a system of adult host homes serving one or two people, a category into which foster parents’ homes could fit. Foster parents’ licenses would be more seamlessly transitioned to care licenses once the children reach adulthood.
For elders, the bill authorizes a system through which family members can continue to be paid — through a temporary change in the federal Medicaid system — for care services provided at home.
The bill’s dual nature is the product of the legislative process. Senate Bill 57, as originally written, was focused on care for disabled foster children reaching adulthood and other disabled adults, said Tony Newman, acting director of senior and disabilities services for the state Department of Health.
It was combined with another measure, Senate Bill 106, sponsored by Senate Majority Leader Cathy Giessel, of Anchorage, that authorizes a more permanent system for family members to be paid for care of elders kept at home, he said.
The foster-youth part of the bill got its start years ago. At the time, some foster parents of disabled youth described some burdensome “disincentives” to continuing providing normal care received at home once the youth aged out, he said. After the youth turned 18, foster parents explained at the time, “their foster care license would no longer apply,” and they would have to go through a cumbersome process to get a different type of care license to keep those young adults with disabilities at home, Newman said.
The part of the bill focused on elder care allows for continuation of what was a temporary relaxation of Medicaid rules in response to the now-ended COVID-19 pandemic emergency. The temporary policy allowed for family members to be paid for care of elders living at home.
Pre-COVID, such payments were generally disallowed and frowned upon, Newman said, and they continue to pose some challenges. There are opportunities for abuse and some blurred lines “because it’s less clear when work begins and work ends,” he said. The state itself has a regulation on the books prohibiting payment to family members for care of elders at home, he noted. “The bill will now allow us to do that, however,” he said.
Supporters of the bill said it addresses both family preferences and practical problems. Many elders and adults with disabilities have had difficulty finding caregivers to visit them or spots at assisted-living homes because Alaska has shortages of both health professionals and facilities, supporters said.
“This bill will benefit not only foster children but all adults with disabilities who would prefer to receive services in a smaller, family-type setting,” Dunleavy said in a statement.
Giessel also weighed in.
“Alaskans struggling with dementia and other complex medical needs will be able to remain in their familiar home surroundings cared for by family members, who are trained and paid to provide that loving care. This is particularly beneficial for rural Alaskans in locations where home care agencies are not available,” she said in the governor’s news release.
The bill passed the Senate unanimously and the House with only one vote in opposition. Supporters included the state’s long-term care ombudsman and the Governor’s Council on Disabilities and Special Education.
Newman said there are currently about 2,000 Alaskans receiving at-home care through a Medicaid program. Those who would be served by the new systems would likely be a subset of the 2,000, he said.
It will take time to set up the new programs. The Department of Health is seeking public input on how to write the regulations, as well as seeking input from the federal government on what is permissible, Newman said.
Like Alaska, other states are facing scarcities of workers to provide at-home or elder care. “The shortage of caregivers is a national problem,” he said.
Other states have responded in ways similar to Alaska, Newman said. Oregon, for example, has established adult foster/care homes that can serve up to five people each.
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