New York State's Medicaid program covers personal care services, also known as home attendant services. This is a type of unskilled, custodial care provided in the home to people with physical or mental impairments that interfere with their ability to independently perform activities of daily living. This article is about procedures in NYC. See this article for statewide information about personal care services.
WHERE TO APPLY - CASA offices are run by the Medicaid program in NYC. They process both aspects of the application: (1) financial eligibility for Medicaid, and (2) approval of the personal service based on the doctor's form "M11q" and a functional assessment, discussed below. If the applicant for personal care does not yet have Medicaid, they can submit a Medicaid application to the CASA at the same time as submitting the M-11q. For more information on Medicaid financial eligibility and applying for home care, read this memo. See this information about where to apply for Medicaid in NYC when you do not want personal care.
HOW TO APPLY - To apply for Medicaid personal care services, you must submit a form signed by the applicant's doctor. In New York City, this form is the M-11q Medical Request for Home Care (April 2010). Note that the M11q form at this link is a new version that will be effective April 1, 2010. Other than some minor changes regarding the physician's certification, this is the first major revision of the form in more than 20 years. A comparison with the old M11q, effective through April 1, 2010, shows that many of the key sections of the form have been deleted. The physician is no longer asked to specify the client's functional limitations, symptoms of mental impairment, level of continence, or need for specific housekeeping or personal care tasks.
The M-11q attached to this article is an electronically fillable PDF form, so you can type your comments into it electronically and print it out. However, depending up on your software, you may not be able to save the form with your comments intact. The official M11q can also be downloaded on the HRA site (not fill-able).
Q-Tips - Helping a doctor to complete the M-11q can be tricky, because the form uses many terms that are not universally understood by doctors. In addition, there are some details that are very important to assessing the need for home care, but which are not solicited on the form. To help you understand how to complete a successful M-11q, we have written a memo called Q-Tips. This version has been revised for the April 2010 M11q. The old version of the Q-Tips memo is also available in Spanish - we hope to update it for the 2010 M11q. Keep in mind that the M-11q is a medical document - non-doctors can assist in its completion, but in the end, a doctor must certify that the contents are true.
Home care advocates have found that the most effective M-11q forms are those that have detailed comments about the applicant's impairments and needs for assistance with activities of daily living. However, the M-11q form does not have much space for comments, and now the April 2010 form removes sections that formerly elicited some detailed comments by the physician. However, the M-11q form explicitly asks the physician to "attach an additional sheet(s) explaining the patient's condition in greater detail." We recommend that the M-11q form always be supplemented by this additional sheet of paper, with handwritten or typed comments spelling out the applicant's need for assistance with Activities of Daily Living in more detail.
WARNING ABOUT "SUPPLEMENT" - We had previously posted a Supplement form created to allow physicians to fill in the gaps of the new M-11q form. We have recently discovered that HRA has a policy of rejecting this form and returning it to the applicant. As a result, we no longer recommend that you use our Supplement to the M-11q. A simple blank sheet of paper with typed or handwritten comments will hopefully be more likely to be accepted. Simply write at the end of the Additional Comments section "continued on separate page" and attach your continuation page with "Form M-11q: Additional Comments (cont'd)" at the top of the page. You may use the checkboxes of our Supplement, as well as our Q-Tips, as guides for the physician in drafting the comments.
30-Day Rule and "Stale" M11qs - State regulation 505.14(b)(3) requires that the physician complete the physician's order (M11q) within 30 days of the medical examination of the client, and that the completed M11q be filed with the local district (CASA) within 30 days of the medical examination. The NYC HRA Home Care Services Program issued a Memo to all CASAs, dated May 26, 1995, that clarifies that as long as a signed M11q is submitted to the CASA within 30 days after the medical examination, it does not become "stale-dated" because it is in the CASA for more than 30 days without being acted upon. Moreover, this Memo clarifies that an M11q continues to be valid for one year after the medical examination.
30-Day Time Limit for HRA/CASA to Process M11q - This time limit was agreed to in the 1978 settlement in Miller v. Bernstein (see par. 7). This is, obviously, not always complied with.
This article was authored by the Evelyn Frank Legal Resources Program of Selfhelp Community Services, Inc.
