Below is an explanation of Medicaid Home Care Providers in New York and how to get Medicaid Home Care in NY.
We also encourage you to download our 7 Tips on Medicaid Home Care from our parent company Edison Home Health Care:
Medicaid is the most common provider under which consumers in New York receive long-term home care. However, the providers of Medicaid home care and the process of obtaining a Medicaid home health aide is often unclear even to the experienced consumer.
Types of Medicaid Home Care Providers
There are a few different types of providers in New York that may be involved in administering a patient’s home care, and it’s important to understand the roles they play. Below we outline some of the most common Medicaid home care providers in New York.
Most recipients of Medicaid home care receive it through a Managed Long Term Care (MLTC) Plan. MLTC Plans operate as an insurance model. As such, most of the services they cover are provided by vendors or contracted providers. Plans do not employ home attendants directly, rather, they contract Licensed Home Care Services Agencies (LHCSAs [lik-suh]) to provide them. Some Medicaid Home Care consumers self-direct their home care through CDPAP (the Consumer Directed Personal Assistance Program), a Medicaid program available in NYC and all of NY State. This allows them choose their own caregivers, including family members who can get paid to care for them. This is popular among the elderly and disabled who prefer to have a child or other family member get paid to take care of them as opposed to receiving care from a stranger.
Another Medicaid Home Care provider are Certified Home Health Agencies (CHHAs [chah]). CHHAs are agencies that provide skilled services such as nursing, physical therapy, and occupational therapy to home-bound patients recently discharged from a hospital or rehabilitation center. Additionally, they will also often provide home health aides to complement these skilled services. CHHAs also do not employ home attendants, rather they contract LHCSAs to provide them. A significant aspect in which CHHAs differ from MLTCs is that the services tend to be short-term.
While most home care consumers that need long-term home care are required to enroll in a MLTC plan, some home care consumers receive their care directly through Medicaid fee for service programs. These include programs such as the NHTD Waiver Program, TBI Waiver Program, and the Office for People With Developmental Disabilities (OPWDD).
How to Obtain Medicaid Home Care
As noted above, Medicaid consumers commonly receive home care in NY via a MLTC plan or through a CHHA.
The method to enroll in an MLTC Plan is a two-step process. The first step requires the patient to go through a nurse’s assessment from the Conflict-Free Evaluation and Enrollment Center (CFEEC). During this evaluation it is verified that the person seeking enrollment does in fact require long-term care.
Once a patient has been approved to enroll in an MLTC Plan, the patient is given the opportunity to select an MLTC Plan of their choice. Once selected, the MLTC Plan then sends another nurse to make a second patient evaluation. After the MLTC completes their own nurse’s assessment, the patient can then be enrolled in the MLTC Plan.
CHHA’s are providers and receiving care does not require an enrollment from a CHHA per se. However a doctor must fill out paperwork to validate the need for home health care. CHHAs then send a nurse to evaluate the patient and determine the services they require.
Get Help Obtaining Medicaid Home Care
To learn more about enrolling in an MLTC Plan through the CFEEC see here. To receive assistance enrolling in an MLTC Plan to receive a Medicaid home attendant, please call us at (718) 838-3838.
To learn more about CHHAs, click here. To receive assistance obtaining Medicaid home care through a CHHA, please call us at (718) 838-3838.