New Limits on Home Care Agencies for NY Managed Long-Term Care Plans

by David Goldfarb

As of early 2018, about 229,000 New Yorkers received health services through the state managed long-term care (MLTC) plans. These plans allow patients to use Medicaid or Medicare to receive home health care. The goal in many cases is to keep patients in their homes as long as possible, so home health care is an essential part of the program.

Managed care providers contract with licensed home care service agencies (LHCSAs) who then provide the care that enrolled patients need. Often, one provider may contract with as many as 200 LHCSAs, since many patients require specialized care and only certain agencies can provide those services. In addition, smaller licensed home care services often provide care to people with specialized cultural or language needs.

Now, the New York state budget for 2019 has placed extreme limits on the number of LHCSAs that may provide services for managed care insurers. The new law limits the number of LHCSAs an insurer can contract with one to every 75 enrollees in the plan.

Ben Noyes, director of communications with the Home Care Association of New York State, is concerned about how these changes will affect consumers. According to Noyes, “We are very concerned about the impact of arbitrary contract limits on continuity of care and individualized contracting relationships that might have specific clinical, cultural or language value, even if the LHCSA does not have the case volume to help an MLTC stay within its contract limit.” Specifically, it may limit the specialized care available to many MLTC enrollees.

Managed Care Enrollment

If the alphabet soup regarding LHCSAs, MLTCs, and Medicare Parts A, B, and C have you confused, you are not alone. Paying for long-term care in New York is a complicated issue, and many seniors do not know where to begin. At Goldfarb Abrandt Salzman & Kutzin LLP, we have been helping seniors apply for benefits and choose the plan that’s right for them for more than 25 years. In this ever-changing landscape, we can ensure that you get the coverage you need when it matters most.

We Can Help Seniors Obtain and Maintain Medicaid Eligibility

Obtaining and Maintaining Medicaid eligibility is a concern for many seniors, particularly when they have assets over the Medicaid limits. The issue is this: if you keep your assets, you will not be eligible for Medicaid, and will need to pay for all your long-term care out-of-pocket. This can significantly deplete the assets you have spending a lifetime saving and may be needed for your future or the needs of a spouse. Fortunately, there are ways that an experienced elder law attorney can help. With careful planning, it may be possible to  to protect some of your assets for your future while still entitling you to Medicaid benefits for long-term managed care.

Consult an Experienced New York Elder Law Lawyer

If you have questions about in-home care, MLTC enrollment, or anything else related to health benefits, you should speak to a New York elder care attorney as soon as you can. To schedule an appointment with an attorney, call (212) 387-8400 or contact us online.