Medicaid Covered Home Care

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.

Eligibility for Medicaid must be established before coverage will be provided. Without proper legal advice, Medicaid requires that you privately pay for your own health care until your life savings is depleted.

Under the changes made in 2013 and 2014, home care has become a more realistic 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:

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.

We have been advised that at the time of the application for Medicaid, you must indicate whether you are applying for managed care home care or for the Nursing Home Transition and Diversion Waiver. The basis for this decision is what level of care your medical evaluation has determined that you need. Therefore, it is important that you discuss with the home care agency conducting the evaluation which home care program they recommend that you apply to receive.

Nursing Home Transition and Diversion Waiver

In addition to the new managed care home care program, there is also a home care program commonly known as "Nursing Home without Walls" or "Nursing Home Transition and Diversion Waiver." This is a skilled nursing care home care program for those whose medical condition would normally require nursing home placement. We have been advised that typically a Medicaid recipient will receive substantially more hours of home care aides and nurses under this program than under the Managed Home Care program.

We have been advised that the initial process is to be evaluated by a home care provider. On the website www.nymedicaidchoice.com, there is substantial information about managed home care along with a list of home care providers that can handle this evaluation. Once you have received an evaluation and are determined medically eligible for home care coverage, and if you are financially eligible, then the next step would be to apply for Medicaid coverage for Home Care.

Does Medicaid Pay for Home Health Care?

Financial Eligibility Rules for Home Health Care Medicaid

In order to qualify for Medicaid covered home care and participate in one of the above programs, you must be both medically eligible and financially eligible.

In 2017, a single person cannot have more than $14,850 in non-exempt assets. For a married couple, the healthy spouse is entitled to keep a minimum spousal allowance of $74,820 up to a maximum of $120,900 of the couple's combined life savings.

Income Rules for Home Health Care Medicaid Coverage

For 2017, a single person is entitled to keep $845 of his/her monthly income. The healthy spouse is entitled to keep at least $3,022.50 of the couple's combined income. If the healthy spouse has income of his/her own above $3,022.50, then the Medicaid Agency will "request" a contribution of 25% of all income above $3,022.50.

No Transfer Penalty for Home Care

If your assets exceed the financial eligibility levels, you can transfer them to another person or to an Irrevocable Trust. There is no transfer penalty. You can transfer your excess life savings and become immediately eligible for Medicaid covered home health care.

Transfer Penalty Reinstated for Nursing Home Care

Although there is no transfer penalty for home care Medicaid eligibility, the transfer penalty does apply if you subsequently enter a Nursing Home. The Medicaid Agency is entitled to look at all your financial transactions for the 5 years immediately preceding your Medicaid application for Nursing Home coverage. The Medicaid Agency can review your bank statements and question each of your deposits and withdrawals for the past 5 years. Therefore, if you have transferred assets to qualify for Medicaid Home Care coverage and enter a Nursing Home within 5 years from the date of the transfer, those transferred funds may need to be returned to you before you apply for Medicaid Nursing Home coverage. Therefore, it is critical that the recipient of transferred funds does not spend those funds.

Navigate New Medicaid Rules with An Elder Law Attorney

In conclusion, the new managed care options for home care coverage make applying for Medicaid covered home health care a viable option for families. There are no transfer penalties and the healthy spouse can now keep more generous life savings and income.

The Koldin Law Center, P.C. handles Medicaid applications for Home Care, Assisted Living and Nursing Home Care Medicaid coverage. Applying for Medicaid is a very challenging time for both the applicant and the family. Substantial assets can be lost if you do not know your legal rights. The Koldin Law Center, P.C. closely monitors the Medicaid laws and court cases to make certain our clients are well-informed of their options.

At the Koldin Law Center, P.C. with offices in Syracuse and New York, we have over 50 years of experience helping elderly individuals plan for immediate crisis and long term care. Our firm represents clients in Onondaga county and throughout all of Upstate New York.

Contact our experienced Upstate New York elder law attorneys to schedule a free initial consultation. We are available for home and hospital visits and our flat fees are very reasonable.