Participant Directed Option

Medicaid Planning
Jason Neufeld
October 4, 2020

Participant Directed Option – PDO is a choice any enrolled member of any of Florida’s Medicaid Waiver long-term care program /  Home and Community Based Services can make. It is for those who desire to remain at home for as long as possible, who require assistance with home-health care. Generally, when my client enrolls in a Medicaid managed care plan (e.g. Humana, Sunshine Health, AETNA, Florida Community Care, etc…) they are given a list of home health agencies that are contracted with the Medicaid managed care organization. The case manager will then approve a certain number of hours per day or per week.

However, for those who would prefer to receive their care from a friend, neighbor, family member, or other trusted caregiver, Florida Medicaid also offers the Participant Directed Option (PDO).

Participant Directed Option (PDO) - choose your own Florida Medicaid Paid Home Caregiver

PDO is offered throughout Florida once a Medicaid Waiver (SMMC-LTC) recipient has been approved for:

  • adult companion care: help with meal preparation, laundry and shopping (sometimes light housekeeping as well such as dusting, vacuuming). An adult companion can also accompany the participant to places outside the home such as restaurants, museums, and parks;  
  • homemaker services: heavier house keeping items such as mopping, laundry, bathroom cleaning, lawn care, pest control, in addition to meal prep;
  • personal care:  help with ADLs such as eating, bathing, getting in and out of bed, dressing, using bathroom;
  • attendant care: this must be provided by a licensed nurse regarding medical needs; and/or
  • intermittent and skilled nursing: provided by a licensed nurse for things like injections, wound care and other medical needs.

Long-Term Care PDO allows the Medicaid recipient to choose who will provide these services and when those services will be provided.

However, the Florida Medicaid participant directed option also means that the Medicaid recipient is responsible for hiring/employing, training and supervising their direct service workers.  

How Much Can a Caregiver Get Paid by Florida Medicaid as part of the PDO program?

Not much. As an example, Humana pays most caregivers (except for intermittent/skilled nursing, which is paid at a higher rate) $10.25 per hour.

When one of our clients is looking to protect their assets and is already receiving extra care by a friend or family member, we'll discuss the personal services contract. When combining is sort of personal caregiving agreement with PDO enrollment we have to be careful not to double pay for duplicate services provided by the employee / direct service worker under a client electing the participant directed option (PDO).

For those without assets, who prefer to select their own caregiver, rather than going through a Medicaid-approved agency - the personal services contract will not be an option, but utilizing the PDO option will still remain available.

Participant Directed Option – Key Terms

Employer / Participant: the Medicaid recipient in need of home-care services is both the participant (someone who lives at home and chooses to participate in the PDO) and the employer (they hire, train, schedule and supervise the direct service worker).

Representative: the Participant may choose a representative to act on his/her behalf to manage their employer responsibilities. The representative will not be paid.

Direct Service Worker: an employee/caregiver that the participant hires to provide PDO services.  The direct service worker is paid by the managed care plan directly, for the number of hours worked that have been preapproved by the plan. Direct Service Workers need have no special skills in order to provide most forms of home health care – except they must be a registered nurse or licensed practical nurse to provide attendant care or intermittent/skilled nursing services.

All direct service workers will have to pass a criminal background screening that will be paid for by Medicaid. They must also be 18 years old or older and authorized to work in the United States.

Timesheet: confirms the hours that the direct service worker provided each day. Each timesheet is signed by the participant and the worker and can be submitted by fax, mail, email and with certain providers, via a smartphone app.

Emergency Back-Up Plan: provides for how the participant will get services if the direct service worker does not show up (e.g. utilizing an agency with in the Florida Medicaid managed care plan’s network). This plan is updated at least once a year.

PDO Participant and Case Manager Responsibilities | PDO Payments

The Participant is responsible for submitting all required paperwork, including timesheets, and submitting it in a timely manner, interviewing/hiring/training/supervising direct service workers (although they are usually a family member – including a spouse or adult child, friend, neighbor or CNA that the participant is already familiar with). The participant should let their Medicaid case manager know if you need to utilize a representative to handle the responsibilities or if they have any other questions regarding the PDO program.

The Case Manager is supposed to be available to explain the PDO program and process, inform the Participant of their responsibilities and helping them find resources, answer questions, and assist in the creation of an emergency back-up plan.

How are the Participant Directed Option Direct Services Workers Paid / taxes handled, etc..?

Luckily, some Medicaid managed care organizations have contracted with a third party to manage the direct-service worker payment/management side.

A few examples: the Humana Long-Term Care Managed Care Program in Florida uses a company called GT Independence to manage the financial side of the self-directed services option for paying caregivers. A company called Public Partnerships provides the same PDO/employee management service for Simply Healthcare, Florida Community Care and AETNA Medicaid Managed Care organizations in Florida.

GT and Public Partnerships will pay caregivers and withhold/pay their wage-related taxes. They are agents operating under Section 3504 of the Internal Revenue Code serving Home Care Service Recipients. GT helps the participants file all necessary forms with the IRS and with Florida Department of Revenue.

All costs associated with such PDO programs are paid for as part of the Medicaid plan of care.

To further discuss your Medicaid planning concerns, please call to schedule a full consultation. We assist clients throughout Florida.

Additional Florida Medicaid Waiver Program Resources

https://www.elderneedslaw.com/blog/florida-medicaid-waiver-waitlist

https://www.elderneedslaw.com/blog/medicaid-waiver-waitlist-and-priority-scores-florida

Jason Neufeld
Jason is committed to assisting and protecting the most vulnerable members of society, through his substantial legal work with the elderly.