New York State launched a new fast track Medicaid home care procedure that processes applications in seven days. This is good news for many families. Home care applicants for New York’s Medicaid programs often wait months before they receive required services. This can be a financial and emotional hardship for many low-income families who are forced to improvise for frail loved ones who can no longer live independently.
In July 2016 New York State implemented a new procedure that requires local Medicaid offices to process and approve applications for home care and the Consumer Directed Personal Assistance Program (CDPAP) in seven days and authorize services in twelve. This comes as a relief for many infirmed seniors.
To qualify for this new fast-turnaround service, a Medicaid applicant must prove he has an “Immediate Need” for home care and confirm that he is not currently receiving care through an agency or through an informal source. He may also qualify if he is currently receiving Medicaid community services such as adult day care, but now has an immediate need for home care.
Even with these qualifications, there are some restrictions. This process does not apply to candidates who require special health care equipment such as respirators or suctioning equipment or to individuals receiving payment from long-term care insurance plans. Anyone who does not qualify must apply for Medicaid through traditional channels.
This new procedure is the result of a New York State law passed in April 2015 that requires all regional Medicaid District Offices to accelerate the application turnaround time from months to days. Prior to this law, Medicaid home care application often remained unprocessed for weeks at a time. The new law was implemented to fix this problem.
New York City residents who qualify for immediate home care must fill out specific government forms. They include an Access NY Health Insurance Application form (DOH-4220), an Access NY Supplement form (DOH-4495A or DOH-5178A), a form submitted by a doctor confirming the applicant needs assistance (an M11Q form) and a statement of need signed by the applicant called an Attestation form (OHIP-0103).
All these forms are available by logging onto the New York’s Department of Health website, www.health.ny.gov/health_care/medicaid#. Once filled out, the forms must be sent to New York’s Human Resource Administration (HRA) for processing. But beware! These forms will not be processed, if they are not completely and correctly filled out.
Once the applications are approved for home care services, the Medicaid office is required to implement services in twelve days. The care recipient can choose between two care options: a Medicaid sponsored home care agency or New York’s Consumer Directed Personal Assistance Program (CDPAP).
Traditional Medicaid offers home care to people who need assistance with activities of daily living (ADLs). These activities include dressing, mobilizing, eating, bathing, and toileting. A nurse first interviews the applicant, determine the number of hours he requires and assigns a certified home attendant.
Applicants can also select care through New York’s Consumer Directed Personal Assistance Program (CDPAP). This program allows adults with disabilities to hire and train a layperson to assist them and have Medicaid pay for the care. CDPAP is less restrictive than traditional home care. It does not limit attendants to doing conventional home care tasks such as housekeeping and personal care. These attendants are permitted to perform medical procedures usually restricted to nurses. They can administer medications, clean tracheotomies, and give injections or assist in intravenous feedings.
CDPAP was first created in 1977 to help young disabled individuals who did not wish to be confined to nursing homes. The service was originally named, Concepts of Independence for the Disabled but was changed to CDPAP in 1995 when it was expanded and became a statewide program. In the last several years, more and more frail elderly have adopted the program.
Originally Medicaid home care services were supplied through state agencies called Community Alternative Systems Agencies (CASAs). The CASAs were responsible for assessing a client’s care needs, determining the number of hours of care he requires, and supplying the individual with home health aides. In 2012 New York State shifted Medicaid home care from CASAs to private Managed Long Term Care companies. It now subcontracts the care to these private companies and pays them a set rate per person.
To be eligible for Medicaid, candidates must meet New York State’s income/asset requirement. For a one-person household the applicant cannot receive more than $825/month in income and have no more than $14,850 in savings and assets. For a two-person household the requirements are a limit of $1209/month in income and $21,750 in asset sand savings. Once a person qualifies, he can apply for any number of Medicaid health services.
New York is considered one of the most progressive states when it comes to long-term care. It offers some programs that are not available in other states. The home care program is particularly generous because it allows applicants to apply and receive services through Medicaid with no look back period. This is different from Institutional Medicaid (Medicaid for nursing homes) that requires a 5-year look back period before being eligible.
In spite of this liberal policy, the amount of paperwork and procedures that is involved in executing some of these services often bog down their implementations. This new state law recognizes the need for faster services for infirmed low-income individuals. It should bring relief for many seniors and their families who require fast efficient care services.