Testimony on Raised Bill 895: AAC Medicaid Coverage of In-Home Counseling Provided by a Home Health Agency

Human Services Committee

February 26, 2019

Submitted By: Stephen Wanczyk-Karp, LMSW

On behalf of the National Association of Social Workers, CT Chapter representing over 2500 members, we are in support of Raised Bill 895. The specialized training of home care social workers is an essential aspect of home care, yet one that is not reimbursable outside of a small portion of CT Home Care Program clients. This raises questions of mental health parity and ignores the well-established connection between body and mind that when treated together provides for better health outcomes, often at significantly reduced costs.

Individuals who qualify for home care are in need of care at home due to the general inability to leave the house. While care at home is most often the preferred location by patients, it can be isolating and difficult for the person, especially when they find themselves restricted in ways that keep them from performing activities of daily living that they are accustomed to. Such situations can demand significant mental adjustments, as well as physical ones. For many persons, especially older adults, their limitations due to health problems lead to anxiety that if not treated may become a depression, of which both conditions inhibit treatment. The person’s behavioral health needs are assessed and proactively treated by the home care social worker.

Acquiring behavioral health treatment in one’s home is extremely difficult to find due to a severe lack of clinicians who will make home visits. This is not caused by a lack of concern for homebound persons, but rather a lack of a reimbursement system that would make such services sustainable. The travel time, insufficient fee scales, and difficulty of being paid for visits outside of a clinician’s office all conspire in a way that leaves homebound individuals without needed psychosocial care. This bill rectifies this problem to a significant degree by making it possible for clinical social work services to be provided and reimbursed when delivered through a home health care agency.

Home health social workers assess the person using a person-in-environment approach that, along with the nursing staff, provides for a comprehensive and integrated understanding of the person’s needs. It is the social worker who works with the family to help them understand how best to address the psychosocial needs of their loved one. It is the social worker who has the command of community services beyond that provided by the home care agency. It is the social worker who assists patients and family members to navigate the maze of financial support programs, and support services for caregivers. It is the social worker who is trained in family dynamics and addresses the behavioral health needs of the patient, plus the counseling needs of caregivers. We urge the Human Services Committee to expand the scope of covered services to the full range of home care social work services.

Raised Bill 895 makes for good health care outcomes. It also makes for good financial outcomes to the State of Connecticut. Persons who are receiving necessary behavioral health will be less likely to require increased physical care, hospitalization or reaching the point where they are no longer able to stay in their own home, causing far greater costs to Medicaid for institutional care.

Behavioral health can be of an acute care nature or a preventative care nature. When we provide mental health care upfront the person has a much better opportunity for improved outcomes, the caregivers are given much needed relief and the State saves on health care spending, all while offering a more humane system of home care.

Social work services are of equal importance to other covered home care services. It is time for Medicaid coverage to reflect this fact.

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