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November 28, 2020


How Changes to New York’s Medicaid Limit Access to Home Care Services

The latest budget changes in New York have created numerous changes to the state’s Medicaid program, but none are more impactful than those to home care services. The current system will make access to much-needed care limited and require you to jump through more hoops than previous systems to receive such care.

If you are already receiving home care services through the state’s Medicaid program, then these changes do not impact you. Instead, you will be grandfathered in. If, however, you intend to seek home care services after October 1, 2020 (less than a month from now), you will be subject to these new guidelines.

CDPAP services and personal care descriptions have changed, and now the definition is much narrower than it was before. The eligibility requirements are stricter, and one of the biggest changes is that you must need assistance for a minimum of three ADLs (Activities of Daily Living) or be diagnosed with dementia to qualify. Furthermore, these services must be prescribed by a physician who is an approved independent assessor contracted under the Department of Health.

Changes the Qualifications for Who Receives CDPAP and Personal Care

After October 1, 2020, you must require physical maneuvering with more than two of the Activities of Daily Living, be diagnosed with Alzheimer’s or dementia, and require supervision to complete at least one ADL per day.

The Role Your Physician and the Assessor Play in Prescribing This Care

Personal care services must be prescribed by a qualified medical professional. This independent assessor is selected by the Department of Health – not you. You can use Maximus to find a provider.

Not only will you not know this physician prescribing these services, but this change will increase the time it takes to receive a diagnosis and prescription for care services. Your treating physician will have to first diagnose you, refer you to the Department of Health, and then you will need to find a qualified contractor. That physician has not treated you personally, and they do not have that same doctor-patient relationship that you are used to. Furthermore, it is on you to schedule the appointment with the DOH-approved physician, and they do not make special scheduling. Therefore, you could wait for weeks just to get your appointment in the first place.

A New Assessment Tool Determines Hours of Care Required

The new changes also bring along a new assessment tool, and that tool helps determine the number of care hours you will need per day. Likewise, the tools will determine how many hours of assistance can be met using telehealth services versus in-home care, and it will also help determine how much community, social, and family support you have outside of those paid for through Medicaid.

Does that mean that family members can impact your in-home care hours received? Yes. For example, if you have a family member living in your home who is capable of caring for you, this will affect how many hours per day you are granted versus having no family member or social support.

Spousal Refusal Does Not Change

Luckily, one change that did not occur is a spousal refusal. In New York, you can still receive in-home care services and long-term care through the state’s Medicaid without your spouse’s income or resources being considered in your eligibility. This is critical, because if your spouse’s resources were considered, you may not meet the income standards to receive care services, even when you cannot afford them financially.

You Must Need ADL Assistance for More Than 120 Days

Not only must you qualify by requiring assistance with three or more ADLs, but you must also need that assistance for a minimum of 120 days. If you do not need assistance with three or more ADLs for 120 days, you can still receive housekeeping assistance for a maximum of 8 hours per week. Housekeeping includes normal house cleaning services, shopping, and laundry.

Now Is the Time to Start Planning for NY Medicaid

You already know that the new lookback period is 2.5 years to qualify for Medicaid if you want community-based care services. Now you know the other changes and limitations for home care services. Whether you know you will need Medicaid, or you just want to be prepared for whatever the future brings, the sooner you start, the better it will be for you and your loved ones.

If you wait until you actually need to apply for Medicaid, you will be subjected to a lookback period, which may make it costly for you to receive in-home care until Medicaid takes over. Planning ahead of time is the only way to ensure that when you truly need it, you get it.

A planning attorney can help you with Medicaid planning now and in the future. They also can adjust your estate plan as the law changes, because after all, who knows what the Medicaid requirements will be five years from now.

The most important step, however, is to start planning today. When you meet with an estate planning attorney, like Andrew M. Lamkin, P.C., you can start rearranging your assets, setting aside funds for the unknown, and even protect your health and wellness if you were to become incapacitated. You can designate someone in your family who will be legally allowed to apply for Medicaid if you become incapacitated or diagnosed with dementia as well.

Estate planning, especially in today’s uncertain economic climate, is critical. You want to protect yourself, ensure you will qualify for government aid when the time comes, and plan for the unknown. Whether you already have an estate plan, or you are just getting started, it is never too late to begin.

Contact the Law Office Andrew M. Lamkin, P.C., today to schedule a free case evaluation. We can do video teleconferencing, if you prefer, so that you can meet with a legal planning team without ever leaving your home.