Private Pay: Not So Private – Podcast

Jason Dorow, Podcast Producer and Co-Host: Hello, everyone. Welcome back to the Champions of Homecare podcast. We're so glad you could join us for another conversation about home care in Minnesota. I'm Jason Dorow with David Hancox. Dave, how you doing today?

David Hancox, Podcast Co-Host and Accra Chief Administrative Officer: I'm great, Jason, how are you doing today? You know, it is an absolutely gorgeous day out there. I kind of hate to be inside on one of the last really nice weeks of the year that we're probably going to have because we know what's coming at us. So it's such a beautiful day out there. I kind of hate to be indoors, but it's good to see you and nice to be doing another podcast.

Jason Dorow: Yeah, capitalize on the fall weather while you can because we know it won't last forever.

David Hancox: That's for sure, unfortunately. But it is a beautiful, beautiful fall day out there. But before we get to today's interview, we want to remind all of our listeners about our most recent episode. We were joined by Gail Larson, an Accra employed caregiver. And Philip Cryan from SEIU, the union that represents health care and home care workers here in Minnesota. And they laid out the wage increases and other benefits that are coming in 2024 and 2025 for PCAs that are working with PCA Choice providers in Minnesota. And they really brought to life what a huge impact these increases will have on the lives of our state caregivers.

Jason Dorow: Yeah, brought to life is a good way of putting it David. The conversation was incredibly informative. Like there's plenty of good information and directions for caregivers to access stipends and other things. But, it was just a vivid conversation with personal stories, demonstrating how PCAs really care about their career and the people they serve, more importantly. So we hope you'll go back and give that a listen if you haven't already.

David Hancox: Absolutely.

Jason Dorow: With that, should we get to today's interview?

David Hancox: Let's go, Jason. All right.

Jason Dorow: So, today we are talking about the Private Pay program at Accra. And for the first time, we have a guest making a return to the show. So let's welcome Val Patino, Accra's Senior Program Director of Financial Management Services and Mental Health. And Val, how are you doing today?

Valerie Patino, Accra's Senior Program Director of FMS and Mental Health: Good afternoon, I'm very well! Excited to be talking about Private Pay services, which is a service that's very different from the other services that we provide with regards to payer source.

David Hancox: Well, it's great having you with us again today, Val, it's nice to have a repeat. You're our first repeat guest!

Valerie Patino: So honored. Thank you.

David Hancox: And also joining us today is Savanna Barrett, the FMS Program Supervisor here at Accra. So Savanna, welcome to you as well.

Savanna Barrett, FMS Program Supervisor: Oh, thanks for having me, guys.

What is Private Pay?

David Hancox: Absolutely. So Val, you started to make a few introductory comments about Private Pay here at Accra. And I, sorry, I talked over top of you briefly there. But for starters, what is Private Pay, and what is the Private Pay program at Accra? And is it available for all kinds of homecare services?

Valerie Patino: Absolutely. Yes. So just as you said Private Pay allows folks to purchase homecare services through their private dollars. So if their insurance doesn't cover homecare services, or they have no other payer source, those folks are privately paying for home care services such as caregiving, homemaking services, etc. through their private pay dollars. It's a wonderful, wonderful way for them to get some extra help in the home. And Accra helps you along the way with employee paperwork, with those tax filings. We're getting those W2s out to your employees at the end of the year, and just helping you with the whole employment process as well.

David Hancox: So Val, thank you for that description. And I just want to make sure that I'm understanding it correctly. So if someone comes to Accra and wants to use Private Pay as a way of accessing services, they can literally choose the services that they want from Accra and we create that opportunity for them using Private Pay dollars. Correct?

Valerie Patino: Correct. They set the job description, they're training the employee, Accra's guiding them, we give them tools and resources on how to create job descriptions, how to have check-ins with employees, etc. But ultimately, they are choosing the services that the client needs.

David Hancox: So they're really just picking off of a menu of services that they choose, that they want to have, so they don't have to fit into any particular category, so to speak.

Valerie Patino: Correct. Homemaking services, personal care services, errands, meal prep, etc.

Why do clients typically elect to use Private Pay?

David Hancox: That's great. So let's jump over to Savanna for a minute. Savanna, why do clients typically elect to choose Private Pay over other options?

Savanna Barrett: Yeah, so folks who typically choose to join our Private Pay program are folks who are in need of homecare services, but maybe they're not covered by their private insurance or their long term insurance. So they may choose to essentially purchase their home care services, but they're private dollars. We also have some folks who are currently in our FMS program, so they're on a waiver, they're receiving, you know, on CDCS, they're receiving staffing hours, but they're maybe only approved for so many hours per week. So we have some people who have joined our Private Pay program to essentially purchase additional staffing hours. I have one who had a staff that they really, really liked, but the staff said they might need to look for another job because they needed more hours. So this allowed the family to keep the staff. It was kind of a win-win situation, because the client was able to receive more hours this way, and they were also able to keep their staff by providing the staff additional hours by adding on the Private Pay hours.

David Hancox: Is anybody eligible to participate in Private Pay?

Savanna Barrett: Yeah, so anybody who is in need of homecare services, and who is able to have the funds to pay for their home care services. So we have, you know, a variety, we have a handful of folks in the Private Pay, who are just, they just need somebody to come in and check on them. Few hours here and there, even if it's just a quick, you know, half hour to an hour a day or just a couple of times a month. And we have some that are in more of need. But yeah, anybody who is in need of homecare services, and has those funds to purchase them can certainly join our Private Pay program.

David Hancox: And they can bill private insurance for that Private Pay, correct?

Savanna Barrett: So we actually are not able to bill their private insurance directly. Our system just currently is not set up for that. We would need to bill a managing party or if they have a separate payer set up like a bank trust or in some cases like a worker's comp agency. But unfortunately, we aren't able to bill their private insurance. It would become a much more complex program than we're equipped for at this time.

David Hancox: Gotcha. That makes perfect sense. Jason, any thoughts?

Private Pay Staffing

Jason Dorow: Given that arrangement, is there a difference in costs when people are working with Private Pay as compared to other services?

Savanna Barrett: Yeah, so just kind of doing a breakdown of the Private Pay fees. So we do, there is a monthly admin fee that the managing party or whoever is responsible to pay, that is $150. And then we also have to bill 12.75% on top of whatever the employee's rate is, and again, that the managing party does determine their staff's rate. So we would budget that 12.75% on top of the rate, and that's going to cover the payroll taxes, the workers comp, and liability insurance. And then we would also charge a background study fee for every background study that we run on their behalf. So, going back to your original question, how does it compare? So really, ultimately, it's going to depend on what the managing party chooses, how many hours they're looking to schedule their staff to work, as well as what rate of pay they would like to pay their staff.

Jason Dorow: Next question is, that compensation and staffing, is that set by the clients in this case? Do they get to decide how much their caregivers are paid in all instances?

Savanna Barrett: Yeah, yep. So whoever is the managing party would establish their own employee's rate of pay. And then they would also schedule, they determine however many hours are needed. So we pay out the employee timesheets, and then we'll bill the managing party the following month for however many hours were paid out.

David Hancox: Are there any services under Private Pay that are not allowable?

Savanna Barrett: The managing party gets to determine types of services. The only thing that's now allowable is nursing duties.

How to Get Started with Private Pay

David Hancox: Well, that makes sense. Sure. Sure. And Val if someone is interested in Private Pay services, how do they get started? I mean, is there someone in particular that they need to be in contact with at Accra, to get this process started?

Valerie Patino: Yes, so we have a team of navigators that can answer any calls and questions that you might have. They'll get you started with the paperwork and preliminary questions and then would go directly over to Savannah. But they can email or call, the email is FMSintake@accracare.org. Or they can call the direct line, 952-491-4150.

David Hancox: Great, wonderful. That's a pretty easy process.

Valerie Patino: Yeah, it is.

David Hancox: Jason?

Jason Dorow: Yeah, as we kind of wrap up this Private Pay conversation, I'm curious, do you two have any tips and tricks, either for people already enrolled in Private Pay, that can maybe make their lives a little easier, or tips and tricks for people that are exploring the opportunity to get into Private Pay?

Valerie Patino: Yeah, we've had a few clients with various different backgrounds, with needing home care services. So they'll call our office and just asking those exploratory questions, and we can really help guide you to see if Private Pay services would be the best, and Accra really does try to make it as affordable as possible for you, and walk alongside you. A great advantage that Accra has is our job board. We have a list of caregivers who are looking for more hours, it might be a great fit. So we'd give you access to that. So you could interview those that you might be interested in learning more about working with.

David Hancox: You know, it's so interesting to hear about the Private Pay, to learn some of the details that you have both shared today, both Val and Savannah. It's just an example of, you know, one more service that Accra provides in this wonderful cadre of services that we currently offer. And to now make people aware of the fact that Private Pay is also available. You know, occasionally you come across someone, a person with a disability, or their family members or whatever, who simply don't want a larger intrusion into their lives by, you know, Medicaid, Medicare, or some type of, you know, county case management service or something like that. They just want to keep it simple and private and to themselves. And this is a wonderful way to accommodate that desire or that need for those individuals who desire that type of service that, you know, whether it's, you want to call it a concierge type service, or what, but it really does make their lives perhaps a little less intrusive or a little less complicated. So it's really nice to know that Accra has this service available, in addition to its other wonderful services as well.

Valerie Patino: So true, Dave, I was just talking to a neighbor the other day, and she moved back from Hawaii to Minnesota to live with her aging mother, and has lived with her for three years now. And is contemplating moving her into memory care and thinks she can put that off for a few more years, because she's got somebody coming into the home to help her out for a few hours a day with meal prep, and just conversing with her mother, giving her that company that's much needed, helping her with daily cares, errand running. And it's just a perfect setup for them to get through the day, and put off moving into a more permanent living situation, which is what her mother does not want. She'd love to stay at home as long as possible. So that's just an example of what the service could provide.

David Hancox: No, and that's a great example. And it's another wonderful example of a type of service that we can provide that Accra can provide that actually prevents more costly, more reclusive, more isolating out-of-home placements. So it's wonderful. And Val, to you and Savanna, thank you both so much for being here today, to share this information with our listeners about, you know, Private Pay at Accra. I think it's probably a program that a lot of people are not aware of, that it exists, or how to go about even getting connected to it. So again, thank you so very, very much for providing this valuable and informative conversation today. Really appreciate it.

Valerie Patino: Thank you for having us.

Savanna Barrett: My pleasure. Thanks for having us.

David Hancox: Absolutely.

Jason Dorow: Thank you both.

David Hancox: Well, Jason, another fantastic conversation about a service that's available here at Accra, that I'm betting that a lot of our listeners don't know a whole lot about, or maybe don't know, have never heard of it before at Accra. So it was really nice to have Val and Savannah here with us to share that valuable information. And, I think we have some news and views right.

All-Terrain Track Chairs at Minnesota State Parks

Jason Dorow: Oh, we do. We can jump right into it. So a couple of items. I think we'll start though, with a new offering at Minnesota State Parks. So obviously we talk a lot about accessibility on this show. And the state of Minnesota is expanding a program to make state parks more accessible for people with disabilities. There are now 13 state parks that have altering track chairs. If you have no idea what I'm talking about, which I personally didn't before learning about this, just Google 'altering track chairs Minnesota', you'll get a visual. But they're electric powered chairs that can be used on designated trails within the park, and can help visitors explore areas of the state parks in new ways, often on trails that are not suitable for typical wheelchairs. So they're designed to navigate mud and snow and sand. They can even climb up inclines. So things that, you know, people who get around in wheelchairs normally couldn't do within the parks. They're available year round in some locations, other places just have them perhaps during the summer, so we know people are going to be more antsy to get outside once the summer rolls around, but you still have the chance to use them here during winter. And a little extra good news, there's no charge. So you'll need a state park vehicle permit to park your car in the park. But no charge for the track chair, just call and reserve it. And given that about 8% of Minnesotans have a mobile disability, this can make the state parks more accessible to a big part of the population that couldn't previously navigate their way around.

MNsure Open Enrollment

David Hancox: You know, I have a friend who has a pretty elaborate wheelchair that he uses. And he actually has adaptations that he can make to his chair, he can pop off the standard tires on the chair, and you can put on enlarged tires, like you see on some of these bicyclists that have the really large, I don't know what they're called. But there's really large kind of balloon tires on their bikes for alternate terrain. But he can also pop on these tracks. And it's almost like a bulldozer type track, you know, that allows them to go on all these alternate terrain. So it's nice to know that the state parks have that available now. Thanks for sharing that, Jason. We also wanted to share some update on Minnesota Health Insurance Open Enrollment, because right now it's in effect in Minnesota for all of the Health Insurance Marketplace programs. The open enrollment period runs through January 15, of 2024. But, if you want your coverage to start on January 1, you need to enroll before December 15th. Let me say that, again, if you want your coverage to start on January 1, you need to enroll before December 15. If you enroll after December 15, your coverage would start on February 1. The insurance marketplace is called MNsure. And you can learn more about that by going to MNsure.org. So that's m n s u r e dot o r g. The website will also allow you to compare several private health care plans with the help of certified brokers all free of charge. So we encourage you to take advantage of that resource, if in fact that is a need that you have. So, a couple of good points of information there for listeners to be aware of. I'm really excited about the additional access to the state parks. I'm so glad you shared that. Jason, that was good information. So, any final thoughts, Jason?

Jason Dorow: I don't think so. I'm so glad that Val and Savannah could join us today. I thought it was another great example of self direction, which was, you know, a focus of the conversation the first time Val came on and talked about FMS with us. Seems like another great example of how Accra and this Private Pay program helps people lead more self directed lives.

David Hancox: Absolutely. I couldn't agree more. So, everybody, thank you for tuning in. It's always a pleasure to know that our listeners are gathering some wonderful information from the podcasts. And we'll see you next time.

Jason Dorow: So long!