Karisha and Environmental Modifications

One of the favorite parts of my job are the home modifications. Each client that is on Medicaid has a life time cap allowance to have modifications done to their home to meet their needs. Most of the modifications case managers do are bathroom modifications, widening doorways and ramps.

These are need based modifications that need to be authorized by the state (because the state aka tax payers are paying for them)

Authorization of Environmental Modifications
A. Environmental modifications are minor physical adaptations to the home, as required by the individual’s Plan of Care/Cost Comparison Budget (POC/CCB), which are necessary to ensure the health, welfare and safety of the individual, which enable the individual to function with greater independence in the home, and without which the individual would require institutionalization.

Purpose of environmental modification:
• Necessary
• Access
• Function as independently as possible in home

B. A lifetime cap of $15,000 is available for environmental modifications. The cap represents a cost for basic modification of an individual’s home for accessibility and safety and accommodates the individual’s needs for housing modifications. The cost of an environmental modification includes all material, equipment, labor, and permits to complete the project. No parts of an environmental modification may be billed separately as part of any other service category (e.g. Specialized Medical Equipment). In addition to the $15,000 lifetime cap, $500 is allowable annually for the repair, replacement, or adjustment to an existing environment modification that was funded by a Home and Community Based Services (HCBS) waiver.
Cost:
• Material
• Equipment
• Labor
• Permits

Permit requirements to be determined by contractor depending on location and scope of job.

Here are some of the things I look at when I assess the client for their modification-

Environmental Safety
• Antiscald devices
• Hand held shower head
• Grab bars for bathroom
• Can remove
o Tub
o Toilet
o Sink
• Can install
o Roll in shower
o Grab bars
o ADA toilet
o Wall mounted sink
• Can install
o Floor if necessary
• Widen doors for access
• Completion of the medication, painting, wall coverings, door trim, flooring etc.. will be matched to the degree possible to the previous color/ style/ design