On Oct. 24, 2016 - NYS DOH issued a Q & A about the new Immediate Need Procedure - 2016 LCM-02 - Immediate Need for Personal Care Services and Consumer Directed Personal Assistance Program (CDPAP). The Q&A clarifies that the local district is required to process the Medicaid application and the assessment of need for home care concurrently.
On Oct. 19, 2016, NYC HRA issued its new procedures for expediting Medicaid applications for people with an immediate need for Medicaid personal care services or Consumer Directed personal assistance services.
BACKGROUND -
In July 2016, the NYS Department of Health launched a new procedure that fast-tracks the approval of Medicaid applications for applicants who have an "Immediate Need" for either personal care or Consumer Directed Personal Assistance services. 16 ADM-02 - Immediate Need for Personal Care Services and Consumer Directed Personal Assistance Services (CDPAP) (PDF) (Attachment) The State directive implements a law passed in April 2015, which requires local Medicaid offices to process and approve a Medicaid application in SEVEN DAYS, and authorize personal care or CDPAP services in TWELVE DAYS, if there is an immediate need for these services.
The new procedures are explained in this article. The procedures require submitting a new Attestation Form that certifies the applicant's immediate need, along with a "physician's order for home care, known as the M11q in NYC. The new procedures are significant for several reasons.
On September 26, 2016 HRA announced that its new procedure on Immediate Needs issued Sept. 23, 2016, was "released in error," and a new procedure would be released soon. When released, the new procedure and new form will be posted in this article.
First, when managed long term care became mandatory in 2012, the "front door was closed" for accessing home care through the local Medicaid office - the role of local Medicaid offices was solely to processing Medicaid applications. Once approved for Medicaid, a "dual eligible" (someone who has Medicaid and Medicare) needed to obtain a Conflict Free assessment, then enroll in a Managed Long Term Care plan. When it passed the 2015 law, the state legislature was responding to reports of long delays endured in applying for Medicaid and going through this MLTC enrollment process.
Second, not only do the procedures bring back the old system of requesting personal care from the local Medicaid office, but they now expedite approval of Medicaid in just SEVEN DAYS, for those who have an immediate need for these home care services. We know that meeting this deadline will pose a challenge for local Medicaid programs and hope that they are given the support they need.
We salute the state legislature and Governor Cuomo for enacting this legislation, and the Department of Health for developing these procedures thoughtfully, taking into account input from NYLAG and other consumer advocates. In particular we commend the Dept. of Health for these features of the procedures that we recommended:
Married applicants may request spousal impoverishment protections for their spouses; before, this budgeting method could only be requested after the individual enrolled in an MLTC plan, causing needless impoverishment. To do so include this Request for Assessment form with the application and note it in your cover letter (page 9 of this link)
People who are temporarily in the hospital or who are in a nursing home may utilize these procedures to request expedited Medicaid and/or home care so that they can return home, as shown in the Attestation Form.
All new applicants for Medicaid are given a fact sheet explaining the new procedures (page1 at this link)
Applicants are eligible if their voluntary informal caregivers cannot continue to provide needed assistance to the applicant. Earlier drafts of the form had suggested that an applicant whose family is currently providing informal care does not have an "immediate need," even if this informal care cannot continue.
Since the procedure is new, be sure to refer to the new ADM when you are applying.
The new procedures are explained in this article.