Walking Through the Process

Step 1- Awareness & Assets

Before completing a referral to pursue Home Services Program, it is important that the primary caregiver(s) take a step back and reflect on the type of support they provide to the individual.  The day-to-day needs of caring for an individual with significant needs often becomes second nature for primary caregivers.   Since the step following a referral is an interview where the individual and primary caregiver(s) share the needs of the individual, it is important to paint an accurate picture.  Therefore, taking time to bring awareness to the care being provided and the needs of the individual will allow the referrer to provide the level of detail and thoroughness that a DHS caseworker will need to make an accurate determination.   

There is an asset limit for individuals completing a referral for DHS Home Services.  If the individual is 18 years of age or older, they cannot have assets over $17,500.  Some assets are exempt, such as the individual’s home, a car, an ABLE account, and others.  If the individual is under 18 years old, then their family cannot have more than $35,000 in assets.  

Step 2- Refer & Respond

Anyone can complete an online referral for DHS Home Services.  Completing the referral will take about 1-2 minutes.  The first question is a checkbox and for individuals seeking DHS Home Services, check the 2nd box (I would like help living independently at home.)

The following information is needed to complete the referral:

• Full name
• Address
• Date of birth
• Social Security Number
• Phone number
• Email address (as a copy of the submitted information will be sent as confirmation to this email)
• Language preference 

If someone other than the individual is completing the online referral, like an educator, then they would complete the Referral Source which includes sharing name, phone, and email.  

Submit the security code as seen on the website and click Submit.  

Both the person referring and the individual’s email address that’s provided in the referral will receive an emailed receipt of the submission.  Search ‘DHS.DRS’ in email to retrieve the receipt.  

After submitting, the referral will be given to a local DHS caseworker.   The caseworker will reach out to the individual using the phone number and email provided in the referral.   The caseworker has around 30 days to reach out to the individual after the referral was made, however this may take longer as the department is notoriously understaffed.   While the time between submitting a referral and contact from a DHS caseworker may feel long, once the individual is contacted, they must respond ASAP!  

A DHS caseworker must make 3 attempts to contact the individual/primary caregiver to begin the process after a referral is made.   A DHS caseworker will reach out by phone and email.  So, if checking voicemails or emails is not part of the individual’s or caregiver’s typical routine consider creating a daily alarm to check both around 30 days after submitting the online referral.  If the caseworker does not reach the individual after 3 attempts, they will close the case, meaning the individual will not be interviewed to be considered for funding.  A DHS caseworker can reach out via phone and email (2 attempts) in 1 day.  Therefore, not responding within 1 day could result in a case being closed.  This is why it is so important to respond to both emails and calls and reply ASAP! 

If calls or emails were missed and not returned before the case closes, another referral can be completed, and the process will start again.  There is no required wait time between submitting referrals. 

When the DHS caseworker connects, they will verify the information on the referral and ask a few basic questions about the individual.  Then, they will set-up a time to interview the individual.  

This interview should be completed in the individual’s home, but may be completed via phone.   

While it may be uncomfortable for the individual to be interviewed in their home, the DHS caseworker will make observations of needs that may not be shared during a phone interview.  The DHS caseworker will also request that the individual/primary caregiver gather some paperwork to have ready for the interview.  Paperwork may include recent medical records, evaluations from doctors, a recent IEP (if the individual is still in school), among other tests and scores documentation.  

During this contact (phone or email) or any future communications, if the DHS caseworker refers the individual to ‘DDD’ or ‘DRS’ services, they may be sharing additional resources to pursue.   DDD services means enrolling the individual on the PUNS waitlist (see PUNS guide email).  DRS services are vocational supports (DRS will be covered in a future email). Besides offering additional resources, the DHS caseworker may be alluding that the individual isn’t eligible or wouldn’t be/isn’t approved for DHS Home Services Program funding.   If this is the case, ask the DHS caseworker to clarify.  Consider sharing that the individual is already on the PUNS list, if they are, and whether the individual is interested in pursuing vocational supports.   

Once an interview date and time is set, take the time to make notes and document the types of support the individual needs both in the home and community and for all activities of daily living.  As noted in Step 1 above, the DHS caseworker is going to ask questions about the support the individual needs and for primary caregivers so much of the day-to-day becomes routine.  Taking the time between the initial contact with the DHS caseworker and the interview to prepare will allow the primary caregiver to share all of the needs of the individual.  

Step 3- Interview to Assess 'Determination of Need'

During the interview with the DHS caseworker, the individual and primary caregiver(s) will be asked questions to help the DHS caseworker develop an understanding of the needs of the individual.  The DHS caseworker will use the feedback from their questions to complete an informal assessment referred to as the Determination of Need (DON).  The score from the Determination of Need assessment informs whether the individual will be approved or denied funding.  

If the score is too low, then it is determined the individual does not meet the need for funding.  

If the individual scores high enough, then they will be approved for funding.  Depending on how high the score is, the more ‘hours’ they will be awarded.   More need equals more hours.  The higher the score, the higher need the individual has, and the more hours they will be awarded.  

Keeping in mind that honesty is always the best policy, when the individual is being interviewed the more detail, evidence, and explanation that can be provided the better understanding the DHS caseworker will have as to the true needs of the individual.  While the DHS caseworker will ask probing questions into activities of daily living, sharing all the ways the individual needs support with personal, recreational, and household tasks during their day and in their community is better.  

For example, let’s say the DHS caseworker asks to share about the individual’s ability to shower themselves.  If the individual needs help and the caregiver shares that, ‘I help them wash their hair and body,’ this provides a general overview of the support they require.  If the caregiver shares, ‘I have to help them undress, check the temperature of the water, help them get into the shower safely, lather and wash their hair and body, rinse thoroughly, assist them to get out of the tub safely, dry their body, and change them into clean clothes,’ this additional information provides a stronger understanding for the DHS caseworker.  The DHS caseworker sees that the individual needs support with their physical safety (entering/exiting the tub, water temperature), personal hygiene (lathering and cleaning their body), and self-care (undressing/redressing).  

If the DHS caseworker asks the individual a question, such as, ‘Do you need any help taking a shower?’ and the individual says ‘no,’ even if that is not true the caseworker will accept that response.   Again, honesty is the best policy during the interview!  

The DHS caseworker will likely inquire about what a typical day looks like for the individual and how their basic needs are met, including eating, self care and personal hygiene, health care procedures, transportation, and general ability to access their home and community-based setting(s).

During the interview, the DHS caseworker will likely ask for any reports, medical evidence, tests and scores, and/or an IEP.   They may also request that a primary caregiver complete Release of Information forms so they can contact the medical professionals who are familiar with the individual.  DHS sees the medical professionals as a neutral party who can further confirm the disability and needs of the individual.  

Having any paperwork ready at the interview and providing the documentation and information they request allows the DHS caseworker to develop the clearest picture of the individual and their needs and will allow them to make the best determination regarding funding. 

Step 4- Wait for Approval or Denial Letter

After the DHS caseworker makes a determination, the individual will receive a letter regarding their approval or denial.   Expect a letter about 60 days after the interview.

If approved, the process will start by developing a Service Plan for the individual, which outlines the type of services they want to receive.  

Also, if the individual is approved and services are not set-up within a timely manner, their case may be closed due to inactivity.  Therefore, once approved the individual and DHS caseworker should work together to set-up and use the funding they were approved to receive.  

Support Services include:

• Personal assistant
• Homemaker services
• Maintenance home health
• Electronic home response
• Home delivered meals
• Adult day care
• Assistive equipment/Assistive devices
• Environmental modifications
• Respite services

An overview of these services can be found HERE under What Services are Offered?  While Personal Assistant and Homemaker Services sound very similar, a distinguishing feature is that a Personal Assistant accepts direction from the individual based on their desires and preferences.  A Homemaker Service provider is charged with taking control of providing care on behalf of the individual.  

Services can be offered in the home and the community.   

If denied, the individual may be directed to ‘DDD’ or ‘DRS’ services, as mentioned in Step 2.  Again, DDD services refers to contacting the local office and requesting for an ISC agent to enroll the individual on the PUNS list.  DRS services refers to vocational supports for volunteer or competitive employment (more about DRS in a future email).  DHS is noting that the individual did not meet the requirements for DHS Home Services Program funding and is offering other resources and options.   

If the individual was denied and you believe they meet the eligibility requirements, an appeal can be filed with Home Care Ombudsman.  

Also, if the individual’s situation changes for any reason, a new referral can be made at anytime and the process will begin again. 

Step 5- After Approval Follow-Up for Services

If approved, the individual will be interviewed by an agency representative and they will award a number of monthly hours based on their DON score and a Service Plan will be developed.   The number of hours awarded depends on the individual’s level of needs. 

After the Service Plan is developed, the individual has 2 options for receiving services.  They can choose to receive services through Managed Care or DRS.   Managed Care is where the individual is given a care coordinator and they oversee implementing the Service Plan.   DRS is where the case is overseen by a caseworker and is considered a ‘straight to Medicaid’ format.  

For finding providers to meet the services outlined in the Service Plan, the individual has two options, Individual provider or Agency provider.  As the titles indicate, an Individual provider means the individual is charged with hiring, training, and supervising their personal care workers and an Agency provider means an agency oversees finding, training, and managing personal care workers.  

Family can be paid as Personal Assistants to provide care to the individual in their home.  The parent does need to have a Social Security Number or visa and these payments are considered income, for tax purposes.    There does need to be at least 2 providers identified, in the event that one provider isn’t able to provide care, and both can be family members.   If family is selected to be paid to provide care to the individual, they will receive a packet to complete to receive payment.   That packet is lengthy, which is to be expected as government funds are used for payment.  The hourly rate for Personal Assistants is set by the state and more information about payroll can be found HERE.  

If the individual does not already have Medicaid, they will need to go through the application and/or enrollment process (see previous Medicaid email for steps).  

Once an individual is approved, a DHS caseworker (a.k.a case manager) will meet with the individual (a.k.a. HSP customers) on a yearly basis to confirm services are being provided and to adjust the Service Plan as needed.    If it is determined that the individual no longer needs services, then services could end.   If services are terminated, reduced, or changed, the individual will receive a letter with notification of any changes 15 days before a Service Plan change is made. 

If the individual was on the PUNS list while they were receiving DHS Home Services Program funding, once they are pulled from the PUNS list, they will need to decide between DHS Home Services or PUNS funding.  If eligible, DHS Home Services can be accessed while the individual is waiting to be pulled from the PUNS list.  Typically, once an individual is pulled from the PUNS list the funding, they would receive from that program is more than they would receive from DHS Home Services, however there are rare cases where this might not be true.  

Since both DHS Home Services and Home and Community Based Services (the funding that comes from waiting on the PUNS list) are both Medicaid Waiver programs, an individual can NOT receive both at the same time, so they must make a choice.