One of the greatest fears for a family with a frail parent or spouse is learning their home care provider is withdrawing service. The family is then faced with the formidable task of finding another agency that will offer equivalent hours and service.
This situation is affecting families throughout the country. Many families who receive Medicaid home care are being notified that their plan is closing or withdrawing from their area. New York home care enrollees are currently confronting this new reality. In the last few months, two of the largest Medicaid home care providers announced they are withdrawing service from select areas of Long Island, Westchester County, and New York City. The two providers, Guildnet and Northshore LIJ announced they will cease serving select metro areas by December 31, 2017.
Northshore LIJ and Guildnet Home Care Agency Closures
Between these two agencies thousands of home care recipients will be affected. Guildnet is withdrawing home care services from approximately 3,000 families in Nassau, Suffolk and Westchester counties. Northshore LIJ has notified almost 5,500 clients that they are withdrawing service from New York City, Nassau and Suffolk Counties.
These Medicaid home health plans, called Managed Long Term Care (MLTC) plans are private agencies that are approved by Medicaid to administer care to the elderly. Medicaid reimburses them for their service, however the MLTC providers receive the same amount per enrollee, regardless if they receive four hours or twelve hours of care per day. Many MLTC’s state that with so many clients requiring more hours, they can no longer afford to stay in business.
This is any family’s worst nightmare. These families are faced with the task of finding another health care plan that will offer the equivalent time and service. Fortunately long-term care advocates in New York have put pressure on the state to take action. In September 2017 the New York State Department of Health passed MLTC Policy 17.02, guidelines that Medicaid home care plans must follow before withdrawing service.
Regulations Protecting Home Care Enrollees
An MLTC must first submit a closure timeline to the Department of Health. Once the timeline is approved the provider must notify each enrollee by mail sixty (60) days prior to the closure. The letter must include a list of active Medicaid home care programs that cover the affected area. It must inform enrollees that if they do not select a plan within the allotted time period, the participant will be auto-assigned to a new plan that will provide equivalent home care services for up to one hundred and twenty (120) days or until the families agree to accept reduced services. This protects clients in the short term by guaranteeing the same number of hours per week for three months.
After the transition period the new plan may propose reducing services but it must offer evidence that the member’s condition has improved to the point that services can be reduced. The family will be informed of the decision in writing and must be told how they can appeal this decision if they do not agree.
This is a hard reality for families who expected to provide their aging parents with a good old age. Cuts in Medicaid and Medicare budgets are putting a strain on home care for older adults. This does not mean that good care is not obtainable. Advocacy groups are making strides in setting guidelines that protect the consumer. It is important for families with frail parents to remain aware of new developments in long term care and take advantage of these protections.