The Expanded In-home Services for the Elderly Program (EISEP)
Chapter 894 of the Laws of 1986 established the Expanded In-home Services for the Elderly Program (EISEP). This program is administered by NYSOFA using uniform statewide program regulations and standards, and implemented and managed locally by the 59 AAAs. Only non-medical in-home services, case management, non-institutional respite and ancillary services are provided under EISEP.
The overall goal of the program is to improve access to, and the availability of, appropriate and cost-effective non-medical support services for non-Medicaid dependent elderly. At the same time, use of EISEP’s non-medical and informal caregivers approach enables older people to stretch their private resources to the point of delaying premature spend down to Medicaid eligibility.
EISEP assists elders who need help with Activities of Daily Living (ADLs: e.g., dressing, bathing, personal care) and Instrumental Activities of Daily Living (IADLs: e.g., shopping, cooking) who want to remain at home and are not eligible for Medicaid. In 2011, the EISEP regulations were amended to provide opportunities for increased consumer control over in home services by providing for Consumer Directed In home Services (CDIS). CDIS under EISEP is a person centered planning approach that empowers the older adult by enabling him/her (or his/her representative) to hire, train and oversee their in-home support workers. Currently, CDIS under EISEP is offered in ten counties (Albany, Broome, Cayuga, Dutchess, Oneida, Onondaga, Orange, Otsego, Tompkins, and Washington). It is expected that this option will become available in additional counties in the 2013-2014 State Fiscal Year.
An essential part of the EISEP program is case management. The program's case managers provide information to elders and their families on what services and supports are available to address their identified needs and wishes and arrange for services that may include non-medical in-home services, non-institutional respite, ancillary services and other services. Programs also utilize standardized screening elements to aid in the consistent delivery of service. supports available in the community. EISEP supplements and sustains care provided by families and friends. Case Managers not only assist the client, but also their families. Even under the best circumstances, caregiving is a physically and emotionally demanding task. When it becomes the primary responsibility of one family member, it can be overwhelming. Case Managers help both client and family members cope with these responsibilities and how they impact on family life, leisure time, work life, personal finances and in many cases physical and mental health.
All EISEP customers meet the programmatic eligibility requirements for Medicaid personal care services - and most are very close to being financially eligible.
In SFY 2011-2012, EISEP provided in-home services to almost 11,650 customers and case management services to almost 42,000 customers. Of those seniors who benefitted from EISEP services: all were frail or disabled, almost 44 percent were at 150% of federal poverty guidelines and were considered low-income, and almost 28 percent were minorities.
For individuals who are unable to pay for the full cost of their care, EISEP funds cover part or all of the costs of needed services. Eighteen percent of EISEP clients were required to cost share.
EISEP is not an entitlement program and, thus, does not serve all older individuals in need. This program operates under a fixed, capped budget and uses a sliding fee scale based on income to determine customer cost sharing requirements. Although EISEP is targeted to low income elderly, clients who are financially able may receive needed services, provided they pay for the services. The amount a client pays depends on his or her income. For individuals who are unable to pay for the full cost of their care, EISEP funds cover part or all of the costs of needed services. Eighteen percent of EISEP clients were required to cost share during SFY 2011-12 and provided almost $1.5 million to expand the program. In addition, other non-cost share clients voluntarily contributed over $332,000 to increase service delivery.