Medicaid: Various Home Care Options
Medicaid offers a variety of home care options each oriented to slightly different needs when planning. It is therefore important when planning to understand the various services available within each program. The type of care provided in each program is usually differentiated by whether the care is skilled or custodial. Skilled care is defined as medical care which requires the involvement of skilled nursing or rehabilitation staff. Some examples of this type of care can include; changing the dressing of a wound, dispensing medications, giving an individual an insulin injection, or providing physical or speech therapy. Custodial care is generally defined as care provided to assist with an individual’s ability to perform their normal activities of daily living (ADL’s). ADL’s are defined as one’s ability to bathe, dress, transfer (i.e. get out of a bed and into a chair), toilet, continence (maintain bladder and bowel control), walk, and feed oneself.
There are three available programs:
The Medicaid Long Term Home Health Care Program
This Medicaid home care program is a coordinated plan of medical, skilled nursing, rehabilitative care, and custodial care provided at home to disabled persons who are medically eligible for placement in a nursing home. This plan offers patients an alternative to nursing home placement.
Who is eligible?
This program is available to individuals who are medically eligible for placement in a nursing home and choose to receive services at home. These individuals must have care costs which are less than the nursing home cost in the county. For an individual to qualify for the Long Term Home Health Program, the Assets/Resources for the Applicant is limited to $14,250 and the Assets/Resources for the non-applying Spouse is $113,640 (subject to the Community Spouse Resource Allowance and Spousal Refusal rules). The Applicant’s Monthly Income Allowance is $367 while the Monthly Income Allowance for the non-applying Spouse is $2,841.
How do I find the Long Term Home Health Care Program?
Individuals can access this program through a hospital discharge planner, the local Department of Social Services (DSS), or a Long Term Home Health Care Provider. However, depending on the circumstances, it may benefit the family if an experienced elder law firm assists in the application process.
The county determines eligibility for the program and DSS authorizes all services that are provided. The following services may be available:
♦ Case management by RNs
♦ Home delivered or congregate meals
♦ Housing improvements and moving assistance
♦ Respiratory therapy
♦ Medical social services, nutrition and dietary services
♦ Respite care, social day care, and social transportation
The DSS is responsible for participating in the periodic reassessment of the services provided and the providers are responsible for obtaining physician orders and administering the assessment tools.
The Medicaid Personal Care Services Program
This Medicaid home care program provides individuals living in the community with services such as housekeeping, and meal preparation. Medicaid Personal Care services, also known as Home Attendant services provide custodial care to people with physical or mental impairments that interfere with their ability to independently perform activities of daily living. Personal Care Aides/Home Attendants may only perform custodial care tasks and they are not allowed to administer skilled care or care that requires the continuing attention of trained medical professionals. It is also important to note that individuals receiving this care must be able to “self direct” (i.e. able to be reminded to take their medications, or to be able to administer their own injections). If the person needing home care is not “self-directing” or cannot manage and direct the home attendant because of Alzheimer’s disease or another mental impairment, then a family member or someone else must perform this function. This person need not live with the Medicaid care recipient but should be closely in touch by either calling daily, be available in an emergency, and visit at least weekly.
Who is eligible?
This program is available through Medicaid, private payment, and some health insurers. For Medicaid qualification in 2012, an individual’s income must not exceed $792 and $1,159 for married couples. Individual’s assets must not exceed $14,250 and a couples assets must not exceed $20,850. For couples that do not meet income or asset eligibility, a spousal refusal can be executed by the non-applying spouse. For individuals over the income amount there will be a monthly overage which can be spent down, or paid directly to Medicaid in order to qualify for Medicaid. In addition, a pooled supplemental needs trust program such as the NYSARC Community Trust may be applied for to shelter the excess income for the recipient.
Who provides the services and how do I access them?
For Medicaid-eligible persons, local social services districts usually contract with home-care agencies that employ aides to provide Medicaid funded personal care services, and New York State oversees the local social services districts administration of the program.
For a person to receive services, his or her doctor must send a completed Physicians Request for Personal Care Aide to the local social services district, which then arranges a social and nursing assessment of the individual. A nurse assessor uses the results of the assessments, together with the physician’s order, to recommend the appropriate amount, frequency and duration of services.
The Consumer Directed Personal Assistance Program (CDAP)
This Medicaid home care program provides an alternative way of receiving Medicaid home care services. Rather than assigning a home care vendor or agency that selects, trains, and schedules the aides, the “consumer”, family member, friend or guardian directing his/her care performs all of these functions. The consumer can hire almost anyone to take care of their custodial care needs, including some extended family members. However, state regulations prohibit the spouse, parent, child, son-in-law or daughter-in-law to perform these tasks. In addition to giving an individual autonomy to hire, train, and direct the aides in the CDAP program, the aides are also permitted to do tasks that otherwise may only be performed by a licensed nurse. It is important to note that the consumer is responsible for arranging coverage when the aide is on vacation, sick, or off duty.
How to Join:
An individual will apply the same way they would apply for Personal Care or Home Attendant services, and must meet all Medicaid eligibility requirements stated in the Medicaid Personal Care Services Program. One should state on their Physician Request for Personal Care Aide and cover letter that they would like to apply for the CDAP program.
This Memorandum is based on current law and is for informational purposes only. It is important that you discuss all legal options and consequences with a qualified elder law attorney prior to any action. Should you wish to discuss your situation with us, please call (631) 424-2800 for a consultation. For additional Memoranda, please call or visit our website at www.elderlaw.pro.
