Home Care in NY

How to Get Home Care in NY

Home Care refers to help provided to assist the elderly and disabled with activites of daily living such as dressing, bathing, eating, and ambulating (moving about). It may be provided by Home Health Aides (HHAs), Personal Care Aides (PCAs), or informal caregivers.

Unfortunately, the process of accessing home care can often be confusing and frustrating for New York’s elderly and disabled. In this guide, we outline some of the common ways that New Yorkers may receive home care and how to access them.

Table of Contents

Know Your Coverage

Is the Consumer Currently in a Facility or at Home?

Consumers with Medicare Only

Accessing Short-Term Home Health Care with Medicare

What Long-Term Options Are Available for Consumers with Medicare Only?

Get Help Obtaining Medicare Home Care

Consumers with Medicare and Medicaid

Different Types of Medicaid Home Care Providers in NY

How to Obtain Medicaid Home Care

Get Help Obtaining Medicaid Home Care

Consumers with Long-Term Care Insurance

Filing a Claim with Your Long-Term Care Insurance Provider

Paying Privately for Home Care

Contacting Home Care Providers

Getting Help

Know Your Coverage

The first step when one wishes to access home care is to understand what insurance coverage they currently have. Common providers that may cover the costs of home care include Medicare, Medicaid, and Long-Term Care Insurance. Some consumers will have more than one form of coverage.

Is the Consumer Currently in a Facility or at Home?

Many consumers seek home care to help them adjust to returning home from a facility such as a hospital or rehabilitation center (Skilled Nursing Facility). In those cases, a discharge planner (often a Social Worker) at the facility can often help with arranging home care services upon the patient’s return home.

Consumers that are home and would like to obtain home care will need to be proactive in contacting the appropriate agencies and providers.

Consumers with Medicare Only

Many consumers only have Medicare, but do not have Medicaid or Long-Term Care Insurance. Traditional Medicare Parts A and B do not cover home care that is considered exclusively “custodial” or “personal care”. 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. Long-term home care generally falls under this category. Some Medicare Advantage plans may offer some coverage for home care that is considered “custodial” or “personal care”.

Traditional Medicare will provide some coverage for home health care provided to address a “medical” or “skilled need”. During this period where the patient requires “skilled care”, Medicare will often provide coverage for some “custodial” or “personal” home 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.

Accessing Short-Term Home Health Care with Medicare

For consumers in a facilty such a hospital or skilled nursing facility, a discharge planner (often a Social Worker) at the facility can often help with arranging home care services upon the patient’s return home. For consumers residing at home, their doctor may be able to arrange services. Additionally, they can reach out to a local home care agency. Many agencies will be happy to help with the leg-work of arranging home care for consumers.

What Long-Term Options Are Available for Consumers with Medicare Only?

Many consumers that only have Medicare feel that they are stuck in an impossible situation with regards to accessing long-term home care. The truth is that many consumers that only have Medicare can qualify for Medicaid as well (which does cover long-term home care). There is a lot of misinformation that is sometimes spread regarding accessing Medicaid and many consumers who were told that they do not qualify can in fact qualify. If someone needs long-term home care, it is often well worth it for them to explore this option. If you would like help applying for Medicaid for home care, please call us at (718) 838-3838. Our friendly staff would be happy to help.

Get Help Obtaining Medicare Home Care

To receive assistance obtaining Medicare home care, please call us at (718) 838-3838. Our friendly staff would be happy to help.

Consumers with Medicare and Medicaid

Many consumers have both Medicare and Medicaid. Medicaid will cover long-term home care and it is the most common provider under which consumers in New York receive long-term home care. For these consumers, it is important to first understand different types of Medicaid home care providers that exist in New York.

Different Types of Medicaid Home Care Providers in NY

There are a few different types of providers in New York that may be involved in administering a consumer’s home care, and it is important to understand the roles they play.

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.

MLTC 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.

Another type of 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 (often upon being discharged from a hospital or rehabilitation center). Additionally, they will also often provide home health aides (HHAs) to complement these skilled services.

CHHAs also do not employ home attendants directly, rather they contract LHCSAs to provide them.

A significant aspect in which CHHA services differ from MLTC services is that CHHA services tend to be short-term.

How to Obtain Medicaid Home Care

The method to enroll in an MLTC plan is a two-step process. The first step requires the consumer to receive an 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 a MLTC plan, the patient is given the opportunity to select a 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.

CHHAs are considered care providers and receiving care from a CHAA does not require an “enrollment” per se. However, a doctor must complete paperwork to validate the need for home health care. CHHAs then send a nurse to evaluate the patient and determine the services required.

Get Help Obtaining Medicaid Home Care

To learn more about enrolling in a MLTC plan through the CFEEC see here. To receive assistance enrolling in a 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.

Consumers with Long-Term Care Insurance

Long-Term Care insurance is insurance that covers the costs of long-term care such as home care or nursing home care. Policies are generally purchased by consumers from private insurers when they do not need long-term care in the anticipation that they may need care at a later time. Long-Term Care Insurance policies vary and it is important to familiarize yourself with your policy to understand what is covered.

For consumers who already need home care, it may be too late to be approved to purchase a policy if they do not already have one.

Filing a Claim with Your Long-Term Care Insurance Provider

Filing a claim with your long-term care insurance provider is often the first step in accessing coverage. They may then send a nurse to conduct an evaluation to verify that you are qualified to receive care. Be sure to find out as many details as possible regarding how much care will be covered and what providers you are allowed to use under the terms of your policy.

Paying Privately for Home Care

Consumers always have the option to pay privately for care. Additionally, if a consumer finds that the care they are receiving through their coverage is insufficient, they may choose to supplement their covered care with private pay home care.

Contacting Home Care Providers

There are different types of home care providers in New York. When contacting a provider, be sure to ascertain what type of provider they are (please see “Home Care Providers in NYC and NY State”). We encourage you to ask what type of care and how much care they feel they can provide based upon your current situation and coverage. We also encourage you to ask how long they anticipate it will take to put care in place and if there will be any other agencies involved in the provision of care.

Getting Help

The New York home care system can sometimes feel like a maze. At Edison Home Health Care, we take pride in our dedication to helping our clients navigate the system, including doing much of the heavy lifting in assisting them with accessing care. If you are looking to obtain home care for yourself, a loved one, or a client, we hope you call us. Our friendly staff can be reached at (718) 838-3838.