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The Various Types of Medicaid Home Care in New York State
New York State has a range of Medicaid home care service programs, each oriented toward slightly different needs and sometimes to different populations. These programs are listed below, with links to detailed information posted on this site.
Beginning in September 2012, for ADULTS age 21+ who have Medicare (known as "dual eligibles"), some of the services listed below can only be accessed by enrolling in a Managed Long Term Care [MLTC] plan. The requirement to enroll in an MLTC plan if one needs long-term home care is being rolled out statewide on a gradual basis - first in New York City in September 2012, then in Long Island and Westchester in January 2013 and Orange and Rockland counties in approximately July 2013.
As of June 2013, most people who do not have Medicare, and who are enrolled in a mainstream Medicaid managed care plan, must access the following home care services through their managed care plan. This includes personal care, Consumer-directed personal assistance, certified home health care, and private duty nursing services.
The different home care services programs are as follows. Click on the hyperlinks for more information.
The United Hospital Fund published, in May 2009, a comprehensive report on Medicaid long-term care programs in New York, which serve 247,000 Medicaid beneficiaries each month and account for roughly one quarter of all Medicaid spending. An Overview of Medicaid Long-Term Care Programs in New York. The report provides an excellent portrait of each program's demographics, usage, and function, using September 2007 as a snapshot.
This chart summarizes some of the key differences between the programs.
ONLINE LIST OF LOMBARDI programs, CHHAs, and hospices -- New York State website listing CHHAs, Long Term Home Health Care Programs (Lombardi), licensed home care services agencies, and hospices by county at http://homecare.nyhealth.gov/ .
FAIR HEARINGS -- Hearings are often required to obtain an increase in hours of personal care/home attendant services or Managed Long Term Care services, to contest denials of applications based on the alleged need for a "higher level of care," etc. Many fair hearing decisions are posted by advocates on the Online Resource Center on the Western New York Law Center website. For access, register and "log in" and select "Fair Hearings" tab to access the database. The database is partly searchable -- by keywords used by advocates when the post decisions, but not by the entire decision. This Digest of Medicaid Fair Hearing Home Care Decisions is another way of identifying hearing decisions on the various types of Medicaid home care listed above, which may be helpful to show a roadmap for preparing for a hearing, or to cite as precedent at a fair hearing.
This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.