Are You Eligible for Self Managed Care?

Are you or your client 18 years of age or older?

yes no

1Is the child you care for eligible to receive AHS Home Care services?

yes no

2Does the child have long-term, unmet, assessed care needs?

yes no

3Does the child you care for require assistance day and night?

yes no

4Does the child you care for have a stable and predictable medical condition and/or stable and predictable care needs?

yes no

5Do you have a suitable environment for the delivery of care?

yes no

6Do you (as parent/guardian) agree to case coordination by your Case Manager on a regular basis while receiving Self Managed Care funds?

yes no

7Are you (as parent/guardian) able and willing to assume the responsibilities and risks associated with managing a Self Managed Care agreement?

yes no

1Are you currently receiving home care?

yes no

2Do you (or the person you are here for) have long term (greater than 6 months) care needs?

yes no

3Do you have Personal Care needs?

yes no

4Do you have needs that AHS Home Care can meet? If you are unsafe in your home, or your care needs are very high, AHS Home Care may need to suggest other ways to address your care.

yes no

5Do you have a stable medical condition and/or stable care needs?

yes no

6Do you have a safe working environment for your potential employee?

yes no

7Do you agree to case coordination by Case Manager?

yes no

8If you manage your own care (or if you are caring for someone) will you be able to understand and abide by the Self Managed Care standards and other regulations impacting the program?

yes no