Medicaid Eligibility For Home Care--Part 1 of 2

October 1, 2014

This edition of the Koldin Law Center E-Newsletter reviews Medicaid covered home care. All past issues of our E-newsletters are saved on our website can be found by clicking here. There have been major changes made to the Medicaid Home Care program in 2013 and 2014. Medicaid covered home care is often overlooked as an alternative to Nursing Home placement. In the past, there were two major disadvantages to Medicaid covered home care.

First, the amount of care provided at home was often insufficient and second, the healthy spouse was often allowed to keep more income and life savings if the ill spouse were placed in a Nursing Home. Under the changes made in 2013 and 2014, home care has become a more viable option. The healthy spouse is now entitled to keep the same amount of income and resources that he/she would be able to keep if the ill spouse is at home or at a Nursing Home. There is no longer a major financial incentive for the healthy spouse to place the ill spouse in a Nursing Home. There is a serious lack of information and procedures by the counties to implement managed home care. As a result, each home care case can be treated differently by each county until this program becomes more established. The procedures for being medically evaluated and applying for Medicaid coverage are still not totally clear and appear to be constantly changing.

There are now 2 main Medicaid covered home care programs for the elderly: (1) Managed Care Home Care Program This Managed Care Home Care program provides services and support to people with health problems and who need assistance. Under this program, the Medicaid recipient chooses to join one of the following 3 plans if medically eligible: (1) Managed Long Term Care (MLTC) Under this plan, you will have a case manager who will work with you to determine what Medicaid covered services you need. You can continue to see your own doctor under your Medicare coverage for your normal health needs that are not covered by this plan. Some examples of Medicaid covered services that you might be eligible to receive under this plan based on your needs are health services at your home including nurses, home health aides, and physical therapists. You can receive assistance with bathing, dressing, and grocery shopping. You can also receive Medicaid coverage for adult day care, social day care, home delivered meals, personal emergency response, and transportation to medical appointments. (2) Medicaid Advantage Plus Under this plan, your Medicare and Medicaid services are all managed together so that your doctors, hospital and home care agency are all in the same plan. You would choose a primary physician who is participating in this plan. All of your Medicare covered services such as doctor office visits, prescriptions, x-rays and chiropractor services would be utilized by providers participating with this plan. Some examples of Medicaid covered services that you might be eligible to receive under this plan based on your needs are health services at your home including nurses, home health aides, and physical therapists. You can receive assistance with bathing, dressing, and grocery shopping. You can also receive Medicaid coverage for adult day care, social day care, home delivered meals, personal emergency response, and transportation to medical appointments. (3) Program of All-Inclusive Care for the Elderly (PACE) Under this plan, your Medicare and Medicaid services are all managed together at the adult day care center.

Health services are provided by a team that includes doctors, nurses, social workers and others. You will be able to spend time at the plan's adult day care center with other plan members and get your medical services at the center. In addition, you may receive home health services as needed. All of your Medicare covered services such as doctor office visits, prescriptions, x-rays and chiropractor services would be utilized by providers participating with this plan usually located at the adult day care center. Some examples of Medicaid covered services that you might be eligible to receive under this plan based on your needs are health services at your home including nurses, home health aides, and physical therapists. You can receive assistance with bathing, dressing, and grocery shopping. You can also receive Medicaid coverage for adult day care, social day care, home delivered meals, personal emergency response, and transportation to medical appointments.