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.   Detailed information on these programs oriented toward advocates is or will be posted on this site.  The programs are:

1. Medicaid Personal Care services (a/k/a Home Attendant services in NYC)

2. Certified Home Health Agency (CHHA) services

3. Consumer Directed Personal Assistance Services

4. Private Duty Nursing or LPN services

5. Waiver programs - Lombardi, Traumatic Brain Injury (TBI), Nursing Home Transition & Diversion Waiver (NHTDW), Care at Home, etc.

6. Managed Long Term Care programs

7. Hospice care

This listing gives the statutory, regulatory, and administrative cites for each of the home care programs, along with leading caselaw.

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 has a new website listing CHHAs, Long Term Home Health Care Programs (Lombardi), licensed home care services agencies, and hospices by county at http://homecare.nyhealth.gov/ .

• NOTE that licensed home care services agencies (LHCSA) may not bill Medicaid or Medicare directly.  You may hire aides from a LHCSA privately or through some private insurance.  Also, if you receive services from a CHHA, waiver program, the aides may be employed by a LHCSA, not by the CHHA or waiver program that is managing the over-all care plan and that is billing Medicaid.  The CHHA or waiver program contracts with the LHCSA to provide the aid services as part of the plan of care, but the overall care is managed by the CHHA or waiver program.  

Continuing Legal Education Program -- Selfhelp conducted a three-part Continuing Legal Education Services in early 2009 on Medicaid Home Care Services that is available for online viewing.  Listing of all online trainings is at  http://onlineresources.wnylc.net/online_training.asp.

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 Selfhelp Community Services, Inc.