When the current agency is not working
We Want to Change Home Care Agencies. What Should We Do First?
Families may want to switch because of missed shifts, poor communication, an unsafe caregiver match, repeated schedule problems, or simply because the current arrangement no longer fits. Under Medicaid or LTSS programs, the transfer process depends on the program, MCO, and delivery model.
Planned Personal Assistance Services only; license pending.
Start with the reason
What exactly needs to change?
Coverage problem
Shifts are repeatedly uncovered, caregivers call out, or the agency does not have enough staff for the approved schedule.
Caregiver fit problem
The attendant relationship is not working, boundaries are poor, or the family does not feel the match is safe or respectful.
Agency problem
Calls are not returned, complaints are not resolved, or the family cannot get clear answers about scheduling, supervision, or the service plan.
If STAR+PLUS is involved
Bring the MCO into the transfer conversation
STAR+PLUS members receiving LTSS have service coordination through their managed care organization. If the family wants another contracted provider, ask the MCO service coordinator what transfer steps apply and how services will be protected during the change.
Current Texas SRO guidance specifically says that if the agency and member cannot resolve concerns, the member may select another agency and contact the MCO to arrange the transfer.
AO, CDS and SRO
The delivery model changes what “switching” means
Agency Option
The provider employs and manages attendants. A provider change usually means moving the authorized service to another contracted agency through the applicable program or MCO process.
CDS
Under Consumer Directed Services, the participant is the employer for designated services. The issue may be changing attendants or the FMSA rather than switching a traditional home-care agency.
SRO
Under Service Responsibility Option, the provider remains employer of record while the member manages much of the attendant’s day-to-day work. The MCO coordinates an agency transfer when needed.
Questions to ask before moving
Protect the service plan while changing the provider
- Is the current authorization still active?
- What is the effective date of the provider transfer?
- Will there be any gap in coverage?
- Does the new provider serve the member’s ZIP code and approved schedule?
- Who will notify the old agency and the new agency?
- Does the family need a new service-planning meeting?
- What happens if the current agency stops staffing before the transfer is complete?
For the delivery-model differences, see our Texas CDS, Agency Option & SRO guide.
Changing agencies should solve a problem, not create a new one