Medicaid Coverage of Home Care in New York

by Goldfarb Abrandt Salzman & Kutzin LLP

Many New Yorkers require home health assistance for a variety of reasons. Some people may need therapy services, others may need bathing assistance or help managing medication, while others may require around-the-clock care by a home health professional.  Whatever type of home care you or a family member may need, however, the cost can be extensive. For this reason, it is important to examine when Medicare and Medicaid benefits will cover this type of service and to plan ahead with the assistance of a senior care law firm. If you would like more information about assistance paying for home care, please do not hesitate to call our skilled elder law attorneys for more information today.

Medicare Coverage of Home Health Care

Medicare has a home health care services component that is too frequently overlooked. Although limited to a maximum of 28 hours per week of skilled nursing and home health aide services or 35 per week, if approved by the administrator of the plan, the provision of the service can be indefinite in duration and without cost to the recipient. To be eligible for the coverage the beneficiary must meet the following requirements: (a) the beneficiary must require and receive intermittent skilled nursing, or physical, occupational or speech therapy; (b) the beneficiary must be homebound (essentially this means the person cannot leave home without assistance); (c) the services must be ordered under a physician’s plan of care; and (d) the services must be provided through an agency approved by Medicare.  A typical Medicare covered claim could include two weekly visits by a nurse or physical therapist, plus four hours of a home health aide care five days a week. Agencies may misunderstand the requirement and attempt to terminate services after a fixed period of time. However, Medicare has been ordered to cover these claims.

Other Options in New York

The programs that provide Medicaid coverage for home care can vary widely from state to state. The following are some programs in New York that can help provide home care assistance to participants:

● Managed Long-Term Care (MLTC) Program – This is a Medicaid program designed to assist eligible participants with disabilities or chronic illnesses who choose to receive the necessary care at home instead of at a nursing home. New York Medicaid now provides most community based long term care services, including personal care assistants through the MTLC program. Effective July 1, 2012, the New York began to require people age 21 and older, eligible for Medicare and Medicaid, and in need of community-based long term care services for more than 120 days, to enroll in Managed Long Term Care (MLTC) plans. This program maximizes the assistance of caregivers in the family while providing other needed professional care from home health aides, skilled nurses, personal care assistants, and others authorized by your doctor. There are different plans within this program and you should discuss your home care needs with an experienced attorney to determine which plan is best for you. The MLTC agency will contract with a Licensed Home Care Agency to provide the services required.

● Consumer-Directed Personal Assistance Program (CDPAP) – In some instances the MLTC agency will contract with a Fiscal Intermediary to provide services provided by a personal care assistant hired and supervised by the Medicaid recipient. This program provides Medicaid coverage for different home services and gives participants a greater amount of flexibility and self-direction in selecting the providers of the services they need.

As you can see, there is a wide variety of Medicaid programs that help seniors in New York receive home care and each program has its own requirements, eligibility criteria, and limitations. It is important that you participate in the program that is right for you to ensure your ability to remain at home and still receive the care you need.

Discuss Your Legal Needs with a New York Senior Law Firm Today

Planning for long-term care – whether at home or at a facility – is a complicated process that should always be overseen by a skilled New York elder law attorney. For more information about your long-term care options, call the law office of Goldfarb Abrandt Salzman & Kutzin LLP at 212-387-8400 or contact us online today.