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 and sometimes to different populations.   These programs are listed below, with links to detailed information posted on this site.  

Beginning in September 2012, for ADULTS age 21+ who have Medicare (known as "dual eligibles"), some of the services listed below can only be accessed by enrolling in a Managed Long Term Care [MLTC] plan.  The requirement to enroll in an MLTC plan if one needs long-term home care is being rolled out statewide on a gradual basis - first in New York City in September 2012, then in Long Island and Westchester in January 2013 and Orange and Rockland counties in approximately July 2013.  

As of June 2013, most people who do not have Medicare,  and who are enrolled in a mainstream Medicaid managed care plan, must access the following home care services through their managed care plan.  This includes personal care, Consumer-directed personal assistance, certified home health care, and private duty nursing services.   

The different home care services programs are as follows.  Click on the hyperlinks for more information.

  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 -

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

  2. Managed Long Term Care programs

  3. Hospice care - as of June 2013, people enrolled in MLTC plans may obtain hospice services from a hospice provider outside the MLTC plan, and do not have to disenroll from the MLTC plan. The MLTC plan continues to provide all other long-term care services.  See State DOH MLTC Policy 13.18;  MLTC Policy 13.18(a): Update MLTC Guidance on Hospice Coverage, MLTC Policy 13.18(b): MLTC Guidance on Hospice Coverage Update; Hospice and MLTC FAQ

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   CHHAs, Licensed Home Care Services Agencies (LHCSA) and hospices -- searchable by  county and region - https://profiles.health.ny.gov/home_care  

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.  


This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

NYLAG



Article ID: 41
Last updated: 21 Dec, 2016
Revision: 6
Medicaid -> Home Care -> The Various Types of Medicaid Home Care in New York State
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