We get a lot of questions. Here are some of the most popular ones:
- I heard that it is impossible to get 24 hour home care covered by Medicaid. Is that accurate?
- What is Medicaid pending home care?
- My nurse and home attendant are coming from two different home care agencies. Why do I need two agencies?
- Will Medicare pay for home care?
- How long does it take for a Medicaid application to be processed?
- I was told that I will have to “spend-down” much of my income to get Medicaid. Is there any way around this?
- What is a pooled income trust?
- My Medicaid application was rejected for excess-income. Is there anything I can do?
- I was told that my Medicaid does not have coverage for long-term care. Why is that? Can I get coverage for long-term care?
- How long after I get Medicaid can I receive home care?
- Will getting Medicaid affect my Medicare?
That is not accurate. While it has gotten more difficult to obtain 24 hour home care covered by Medicaid, it is still very much available. We have been successful in obtaining 24 hour Medicaid home care for many of our clients. To learn about obtaining 24 hour Medicaid home care, click here.
What is Medicaid pending home care?
Medicaid pending home care means that a patient receives Medicaid level home care services while their Medicaid application is processing. We have been successful in obtaining Medicaid pending services for many of our clients. To learn more about Medicaid pending home care, click here.
My nurse and home health aide are coming from two different home care agencies. Why do I need two agencies?
In New York, if someone is receiving home care through insurance (Medicare, Medicaid, or commercial), there will usually be more than one agency involved in the provision of care. This is because different types of home care providers are licensed to provide different services. For example, a Certified Home Health Agency (CHHA) may provide a patient with nursing and physical therapy, and sub-contract a licensed home care services agency (LHCSA) to provide a home health aide. To learn more about different types of home care providers, click here.
Will Medicare pay for home care?
Long-term home care, often referred to as custodial or personal care, is not covered by Medicare. This refers to care that is not being provided to address a medical need, but rather to assist with activities of daily living (ADLs) such as ambulating, dressing, bathing, eating, and toileting. Medicare will provide some coverage for home health care provided to address a “medical need”. During this period where the patient requires “medical care”, Medicare will often provide coverage for some custodial care in a supporting role.
Medicare home care services tend to be limited both in terms of the amount of services provided and their duration. However, they can be helpful for someone who needs help adjusting at home after a hospitalization or stay in a rehab. Additionally, they can help bridge the waiting period for someone who needs long-term home care and is working on a Medicaid application, as well as provide some financial relief for patients that are paying privately for home care.
How long does it take for a Medicaid application to be processed?
Most applications that we submit are approved in 4 – 5 weeks. This is a generalization; some applications take longer than that to process and some shorter. Additionally, prior results are not a guarantee of future outcomes.
I was told that I will have to “spend-down” much of my income to get Medicaid. Is there any way around this?
There are a number of ways in which people with income above the Medicaid limit can qualify without “spending-down”. Click here for descriptions of some common ways.
What is a pooled income trust?
Sheltering excess income in a pooled-income trust is one of the most popular ways for someone above the income limit to qualify for Medicaid. NY State policy is that excess income placed in a pooled income trust (the name comes from the way the money is held by the trust, but each beneficiary has their own account) by a disabled individual be disregarded for Community Medicaid budgeting. Disability is almost never difficult to prove for someone who requires long-term care. Money placed into a pooled income trust can never be withdrawn as cash. Rather, the trust can pay bills in the name of the beneficiary.
My Medicaid application was rejected for excess-income. Is there anything I can do?
There are options for those who have been rejected. It can be helpful to contact an agency or advocate that has experience with such situations. We provide free assistance with this issue. Please feel free to give us a call – 718-838-3838.
I was told that my Medicaid does not have coverage for long-term care. Why is that? Can I get coverage for long-term care?
While theoretically only those who did not document their resources at the time of application should not have coverage for long-term care, there is a glitch in the Medicaid system that will sometimes cause it to show “No Coverage for Long-Term Care” even for beneficiaries that did document their resources. This issue often arises with beneficiaries who have excess-income. The good news is that there are fixes for both situations. If you have been told that your Medicaid does not have coverage for long-term care, it can be helpful to contact an agency or advocate with experience in getting this issue resolved. We provide free assistance with this issue. Please feel free to give us a call – 718-838-3838.
How long after I get Medicaid can I receive home care?
Medicaid home care is usually authorized by either a Certified Home Health Agency (CHHA) or Managed Long-Term Care (MLTC) plan. CHHAs can provide Medicaid services immediately after Medicaid is approved. In fact, CHHAs will sometimes even provide Medicaid level home care while a patient’s application is still pending. Patients enrolling in a MLTC plan must go through an enrollment process that often takes between 3 and 6 weeks. Click here for a description of the process.
Will getting Medicaid affect my Medicare?
Medicaid is by law intended to be the payer of last resort. As such, all other third-party resources, including Medicare, must first meet their legal obligation to pay claims before Medicaid pays. Therefore, Medicare will still remain the primary coverage, and Medicaid will cover things within its benefits package that Medicare will not cover.
There is a notable situation where getting Medicaid can adversely affect a retiree’s coverage. Interestingly, it is not Medicaid that causes the problem. When people get Medicaid, if they do not already have Medicare Part D plan for prescription drugs, they are auto-enrolled in a free Part D plan. The government is trying to do these people a favor by giving them prescription drug coverage. Some people have health coverage through a pension that includes prescription drug coverage. Many of these pension plans do not allow their members to have a Medicare Part D plan as well, and if members get a Part D plan, they forfeit their pension coverage. This is sometimes an all or nothing deal where the member will have to forfeit all the pension healthcare coverage, not just the prescription drug coverage. If someone wants to keep his pension coverage, he must call Medicare and opt out of auto-enrollment. If he has already been assigned to a plan, he may also have to call the plan provider to disenroll.
Another thing to bear in mind is that three of the four Managed Long-Term Care (MLTC) plan types manage their members’ Medicare benefits as well. If someone enrolls in one of those plan types, it may have a very large impact on his Medicare. Click here for descriptions of each of the four plan types.