Pathways
51 Reimbursement Pathways
MD / VA / DC / PA / NY / National · Assistive Technology, Enabling Technology & Remote Supports · Same portal forms support all pathways — reports change by pathway.
This page lists every reimbursement and funding pathway we have mapped. For the routes most families and facilities use, the portal provides guided matching and ready-to-submit evidence — start with Start Here. The remaining pathways are documented here for reference and professional guidance.
Remote Supports & Enabling Technology
Across these pathways, Luka Bear is positioned as a Remote Supports / Enabling Technology solution — an in-room assistive companion plus a Caregiver App that lets an approved person support someone remotely, increasing independence at home while reducing required on-site staff hours. Many state HCBS waivers recognize Remote Supports, Enabling Technology, and assistive technology under self-direction / participant-directed budgets.
For I/DD support coordinators and DD agencies, the fastest route is usually the state's own Remote Supports / Enabling Technology or assistive-technology service definition; families using self-directed budgets can add Luka as assistive / enabling technology. The assessment recommends the right pathway automatically. See Remote Supports on lukabear.net →
AI-Enabled Assistive Technology & Remote Supports — Peer-State Precedent
There is now a real peer-state precedent for AI-enabled functional assistive technology in public aging and HCBS contexts. New York established the best-known statewide precedent through NYSOFA and ElliQ, and Washington Medicaid approved ElliQ on March 18, 2026 under code SA077_U2 within the Washington HCBS Smart Care Device benefit.
Why it matters: this gives Luka Bear a stronger policy narrative for Medicaid AT, HCBS smart-care review, and facility-facing functional assistive technology positioning across additional states.
Evidence Burden Key
| NONE | Documentation-driven only. No formal outcomes metrics required. Approval based on medical necessity, functional need, or plan-of-service criteria. |
|---|---|
| LOW | Claims-based. Light evidence required: caregiver burden, respite hours, engagement data. No clinical trial needed. |
| MEDIUM | Outcomes reporting required. ER/hospital avoidance data, ZBI-22, UCLA loneliness, or similar validated measures. |
| GRANT | Research or grant-funded. Aggregate outcomes data and population-level reporting required. |
NO METRICS - Documentation-Driven (27 Pathways)
| Pathway | Type | Jurisdiction | Key Portal Data | Metrics | Annual Limit |
|---|---|---|---|---|---|
| National / Any State | |||||
| LTC Insurance (Alternate Plan of Care) | Insurance | Any | Placement outlook, ZBI, caregiver burden, Letter of Medical Necessity | NONE | Varies by policy |
| HSA / FSA (Health Savings / Flexible Spending Account) | Tax Benefit | Any | Physician Letter of Medical Necessity, engagement evidence | NONE | $3,850-$7,750/yr (IRS) |
| Dependent Care FSA (DCFSA) | Employer Benefit | Any | Qualifying dependent care need, employer plan documentation | NONE | Up to $5,000/yr |
| VA PCAFC Caregiver Stipend | Veterans | National | Caregiver burden, respite hours, functional status - stipend unrestricted cash | NONE | Varies by rating |
| VA Aid & Attendance Pension | Veterans | National | Functional limitation, need for daily care assistance, caregiver burden | NONE | $700-$1,800/mo add-on |
| VA Veteran-Directed Care (VDC) | Veterans / Medicaid | National | VA HBPC enrollment, provider-supported care plan, daily living assistance need | NONE | Per care plan budget |
| VSO Grants (American Legion, VFW, DAV) | Veterans Charity | National | Veteran status, functional need, assistive technology justification | NONE | $500-$3,000 |
| Local Alzheimer's Association Chapter Grants | Foundation | National | Dementia diagnosis, caregiver need, functional support documentation | NONE | $500-$2,000 typical |
| Maryland | |||||
| Maryland CFC (1915k) / Self-Direction | Medicaid | Maryland | ADL/IADL linkage, independence gain, cost avoidance, POS quote - provider enrollment currently in process | NONE | $15,780 / 3-yr cap |
| Financial Mgmt Services (FMS) - MD | Self-Direction | Maryland | Participant-directed budget, plan of service justification | NONE | Per POS budget |
| State AT Program (ACL/AT Act) - MD | State Grant | Maryland | Functional need documentation, ADL/IADL assessment | NONE | Varies |
| Virginia | |||||
| Virginia CCC Plus Waiver (Assistive Technology) | Medicaid | Virginia | Medical necessity narrative, prevent institutionalization, cost-effectiveness | NONE | $5,000/yr |
| Consumer Directed Services (CDS) - CCC Plus | Medicaid | Virginia | Attendant payroll / personal care worker route only - not used for Luka device purchase | NONE | Per participant budget |
| Financial Mgmt Services (FMS) - VA (PPL) | Self-Direction | Virginia | Participant-directed budget, plan of service justification | NONE | Per POS budget |
| Virginia AT Program (TTAP) | State Grant | Virginia | Functional limitation, assistive technology need, independence support | NONE | Device loans/grants |
| Washington DC | |||||
| DC EPD Waiver - Services My Way (Indiv.-Directed Goods & Svcs) | Medicaid | Washington DC | PCSP need, safety increase, reduces other Medicaid services - vendor registration with GT Independence still in process | NONE | Per PCSP |
| Financial Mgmt Services (FMS) - DC | Self-Direction | Washington DC | Participant-directed budget, plan of service justification | NONE | Per POS budget |
| State AT Program (ACL/AT Act) - DC | State Grant | Washington DC | Functional need documentation, ADL/IADL assessment | NONE | Varies |
| Pennsylvania | |||||
| PA CHC (Community HealthChoices) - Participant Direction | Medicaid | Pennsylvania | ADL/IADL needs, independence support, plan-of-service justification, cost vs. aide hours | NONE | $20K-$80K+/yr per budget |
| PA HCBS Waivers (Aging, OBRA, Independence) | Medicaid Waiver | Pennsylvania | Functional need, safety improvement, prevent institutionalization, cognitive support | NONE | $30K-$100K+/yr |
| TechOWL (PA Assistive Technology Act Program) | State/Federal Grant | Pennsylvania | Functional limitation, independence need, caregiver burden documentation | NONE | Device loans/grants |
| PA OPTIONS Program (Dept. of Aging) | State Program | Pennsylvania | Aging-related functional needs, caregiver support, independence documentation | NONE | $500-$2,000+ |
| PA Older Adult Daily Living (OADL) | State Program | Pennsylvania | Functional limitation, daily living assistance need, independence support | NONE | $300-$1,500 |
| New York | |||||
| NY CDPAP (Consumer Directed Personal Assistance Program) | Medicaid | New York | ADL/IADL needs, independence support, plan-of-service justification - same model as VA CDS | NONE | Per participant budget |
| NY TBI Waiver - Self-Direction Option | Medicaid Waiver | New York | Traumatic brain injury / cognitive impairment, care plan inclusion, budget justification | NONE | Per self-directed budget |
| NY NHTD Waiver - Self-Direction Option | Medicaid Waiver | New York | Nursing home transition, community integration, care plan inclusion, supervision support | NONE | Per self-directed budget |
| NYSOFA / NY Office for the Aging Programs | State Program | New York | Aging-related functional need, caregiver support, independence documentation - ElliQ precedent | NONE | Varies |
LOW METRICS - Claims-Based Evidence (15 Pathways)
| Pathway | Type | Jurisdiction | Key Portal Data | Metrics | Annual Limit |
|---|---|---|---|---|---|
| National / Any State | |||||
| GUIDE Model (CMS Innovation) | CMS Innovation | National | Caregiver burden, respite hours, care events, Luka engagement data | LOW | $2,500/patient/yr |
| PACE / LIFE Programs | Managed Care | National | Cost vs. aide hours, engagement data, care events | LOW | Capitated budget |
| Medicare Advantage SSBC | Medicare Adv. | National | Loneliness score, engagement metrics, non-medical support value | LOW | $0-$500/yr benefit |
| Home Care Agency Partnerships | Private Pay | Any | Supplement to aide hours, engagement data, safety events | LOW | Per contract |
| AAA / NFCSP (Caregiver Support) | Federal Grant | National | Caregiver burden, social isolation, respite use | LOW | $500-$2,000/case |
| TRICARE (Military Health Insurance) | Military Insur. | National | Functional need, non-covered wellness supplement, cost justification vs. aide hours | LOW | Per plan |
| Maryland | |||||
| MCO In-Lieu-of-Services (MD MCOs) | Medicaid MCO | Maryland | Cost comparison to aide hours, functional outcomes, engagement data | LOW | Per MCO approval |
| Lifespan Respite (CHAPS / MD) | State Respite | Maryland | Respite hours gained, caregiver burden score, care events | LOW | $500-$3,000/yr |
| Virginia | |||||
| Lifespan Respite - VA | State Respite | Virginia | Respite hours gained, caregiver burden score, care events | LOW | $500-$3,000/yr |
| Washington DC | |||||
| Lifespan Respite - DC | State Respite | Washington DC | Respite hours gained, caregiver burden score, care events | LOW | $500-$3,000/yr |
| Pennsylvania | |||||
| PA CHC MCO (UPMC, AmeriHealth) - In-Lieu-of-Services | Medicaid MCO | Pennsylvania | Cost comparison vs. aide hours, engagement data, caregiver burden | LOW | Per MCO approval |
| PA CHC - Service Coordination / LTSS Authorization | Medicaid | Pennsylvania | Service plan inclusion, cost substitution vs. aide hours - SC is real gatekeeper | LOW | Included in CHC budgets |
| PA Area Agencies on Aging (AAA) - Caregiver Support | Federal/State (OAA) | Pennsylvania | Caregiver burden, respite need, social isolation | LOW | $500-$2,500+ |
| PA Lifespan Respite Program | State/Federal | Pennsylvania | Respite hours gained, caregiver burden score, care events | LOW | $500-$3,000 |
| New York | |||||
| NY AAA / EISEP (Expanded In-Home Services for Elderly) | Federal/State | New York | Caregiver burden, respite hours, functional support need, social isolation | LOW | $500-$2,000/case |
Medicare Advantage SSBCI status: Future pathway - in development. No active plan contracts at this time. Target: Q3-Q4 2026.
MEDIUM METRICS - Outcomes Reporting Required (3 Pathways)
| Pathway | Type | Jurisdiction | Key Portal Data | Metrics | Annual Limit |
|---|---|---|---|---|---|
| ACO / Value-Based Care | Medicare ACO | National | ER visits avoided, hospitalizations, utilization trends, ZBI | MEDIUM | Per ACO contract |
| CDC BOLD Program | Federal Grant | National | Cognitive engagement, isolation reduction, caregiver measures | MEDIUM | $50K-$300K grant |
| ALF / Memory Care / SNF Deployment | Institutional | Any | Facility-level engagement, safety events, care outcomes | MEDIUM | Per facility deal |
GRANT / RESEARCH - Aggregate Outcomes Data (6 Pathways)
| Pathway | Type | Jurisdiction | Key Portal Data | Metrics | Annual Limit |
|---|---|---|---|---|---|
| NIH / NIA SBIR-STTR | Federal Grant | National | Aggregate outcomes, research metrics, validated measures (ZBI, UCLA) | GRANT | $300K-$2M |
| Alzheimer's Association Research Grants | Foundation | National | Caregiver burden, dementia-specific engagement, safety data - population level | GRANT | Varies |
| State Innovation Grants (SAMHSA/CMS) | State/Federal | MD/VA/DC/PA | Population outcomes, cost avoidance, equity measures | GRANT | Varies |
| John A. Hartford Foundation | Foundation | National | Aging-in-place innovation, caregiver outcomes, care model transformation | GRANT | $50K-$500K |
| ACL Innovation Grants (Admin. for Community Living) | Federal Grant | National | Community-based supports, assistive technology, older adult independence | GRANT | $200K-$1M |
| Robert Wood Johnson Foundation | Foundation | National | Health equity, aging population outcomes, caregiver support innovation | GRANT | Varies |
Priority Action Ranking
| Rank | Pathway | Why First | Details |
|---|---|---|---|
| #1 | Virginia CCC Plus AT Category | ACTIVE COVERAGE INQUIRY | Assistive Technology category under the CCC Plus Waiver. Enrollment confirmed, with prior authorization routed through the member's MCO care manager. |
| #1 | DC Services My Way (Individual-Directed Goods) | FLEXIBLE AFTER VENDOR SETUP | IDGS vendor registration with GT Independence is still in process. Contact us before initiating so families do not start too early. |
| #2 | HSA / FSA + Dependent Care FSA | ZERO FRICTION | Doctor note + receipt. Self-administered. No approval process. Fastest first revenue. |
| #2 | VA PCAFC Stipend | CASH IN HAND | 57,000 caregivers already approved. Unrestricted monthly cash. No new approval needed. |
| #3 | PA CHC Participant Direction | LARGEST MARKET | Large Pennsylvania consumer-directed opportunity with the biggest regional population. |
| #4 | NY CDPAP + NYSOFA | STRONGEST PRECEDENT | New York was the first state to approve and deploy AI companion technology at scale via NYSOFA and ElliQ. |
| #5 | Maryland CFC (1915k) | SCALING PLAY | Provider enrollment is still in process with Maryland OLTSS policy review. Contact us before pursuing so the timeline and pathway fit are confirmed. |
Virginia = active AT coverage inquiry | DC = flexible once vendor registration is complete | PA = largest market | MD = institutional scale after policy resolution | NY = strongest precedent (first ElliQ state)