N.Y.C. Lawyers Must Change Home Care Application Procedures - Beginning Monday, September 17, 2012, applications for Home Care will not be accepted at the local Community Alternative Systems Agency (CASA) offices, with limited exceptions.
The CASAs, the department of the N.Y.C. Human Resources Administration that processes Home Care applications, will only accept Home Care applications for those applying for Hospice, Consumer-Directed Personal Assistance Program (CDPAP), Traumatic Brain Injury (TBI) Waiver participants or applicants, Nursing Home Transition & Diversion Waiver (NHTDW) participants or applicants or those seeking Lombardi (long term home health care waiver program services).
The Federal Government has given New York State the go ahead to make Managed Long Term Care (MLTC) for Medicaid recipients over 21 years old MANDATORY for those needing community based long term care services. These changes will have a major impact on senior citizens throughout New York State.
This mandate will also apply to N.Y.C. residents and seniors who have Medicare and receive or who are applying for Home Care services. This is the beginning of the end of straight Medicaid for Home Care services for seniors. Seniors seeking Home Care services will now have to apply for Home Care services through a MLTC vendor. Under the managed care plan, a recipient can only use providers that are within their network. Previously, under straight Medicaid, a recipient could use any provider that accepted Medicaid.
N.Y.C. Medicaid recipients will begin receiving notices from the Human Resources Administration to select a managed care provider and when they do, they will have 60 days to select a managed care provider. Failure to make a selection will result in a selection being made on your behalf. These changes will be phased in by January 2013.
The potential effect of these changes is that the managed care providers will be paid a fee for providing a bundle of services that will cause them to limit the amount of Home Care services provided. It could also result in a number of seniors being recommended or referred to nursing homes if the managed care provider decides that the amount of Home Care services needed is more than they want to provide. Legal advocacy to prevent unwarranted referrals to nursing homes will be required. Seniors and others receiving Medicaid may also have to change their doctor if that doctor is not part of the managed care plan's network of doctors.
Attorney Tanya Hobson-Williams is on the Executive Committee of the New York State Bar Association, Medicaid Litigation and Fair Hearing Committee. Attorney Hobson-Williams and her Elder Law Firm Hobson-Williams, P.C. advocate on behalf of their clients to ensure that clients receive the most up to date legal information and advice to optimize their Medicaid benefits. www.BusinessandElderLaw.com
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