Posted by: BlogMaster | May 24, 2016

Elder Care Update – Can Nursing Home Care Be Avoided or Delayed?

BPA Blog 02-17-15   New York State Medicaid administers a comprehensive community home care program called Managed Long Term Care (MLTC) on Long Island, and New York City and its boroughs. Long Island is well served by MLTC programs, but there are issues you need to be aware of – that I will discuss in my next two blogs.

What is MLTC?

Managed Long Term Care is the program administered by the local Medicaid department for home care aides in the home; adult day care or dementia care at a senior center (two programs: social model day care and medical model day care); transportation to medical appointments; and nursing in the home and similar services.

To qualify for MLTC, you need to follow a three-step process:

Step 1

Apply for Medicaid at the local department of social services. In 2016, an unmarried person can own up to $14,850 of countable resources. Examples of resources that don’t count: your home (if the net equity value is less than $828,000), a motor vehicle, retirement accounts which are paying the required distributions according to Medicaid rules, term life insurance, a burial plot and a funeral contract. Consult with a qualified elder law attorney to learn about other non-countable resources.

Your family member may also need to legally shelter monthly income. In 2016, an unmarried person may keep up to $825/month of income (pension, social security, interest, retirement distributions, veteran’s pension). Excess income should be deposited to a Community Pooled Trust. Which trust is right for you and what is the timing for joining the trust? Consult with a qualified elder law attorney to learn how this may apply to your unique situation.

There is no “look back” for Medicaid Home Care applications. Typically, three months of financials are submitted plus proof of all transfers from the applicant to other persons. If nursing home care is needed in the future, these transfers may mean Medicaid will not pay for care in a nursing home. A consultation with a qualified elder law attorney is essential.

Important reminder: A non-lawyer cannot give you legal advice.

Step 2 –

After the application is accepted, a Conflict-Free Assessment is required performed by a state-contract agency determines if your family member needs home care assistance for at least 120 days (long term). MAXIMUS is the agency currently scheduling the assessments. A family member should always be present with the applicant when the agency conducts its assessment. To request the assessment, call 1-855-222-8350.

Step 3

Select and contact your managed care agency for delivery of the services. The MLTC must send its own nurse to assess and create the Medicaid recipient’s care plan, and bring enrollment forms. Timing is critical because NY State only allows the MLTC to begin its services on the 1st day of a month. The MLTC must schedule the visit, send its nurse, conduct the assessment and file the assessment by the 20th of the month. If this timetable is not met, the start of services for the Medicaid recipient (home care aide, day care and transportation) will be delayed by another month, creating a ‘gap’ delay. It is important to know that the nurse will bring forms to enroll the Medicaid recipient in the managed care plan. Be sure to sign the enrollment forms IF you decide to use the particular MLTC agency – and give them to the nurse before he or she leaves or send the forms back to the MLTC.

For a list of plans, go to the NYS Department of Health website: http://www.health.ny.gov/health_care/managed_care/mltc/mltcplans.htm

My next blog will discuss the “bumps on the road” to Medicaid for home care services.

 

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