Sometimes people find themselves in need of home care immediately, but without the funds to pay for it. For people in this position, Medicaid pending services can be a real lifesaver.
What is Medicaid pending home care?
What type of agency can provide Medicaid pending home care?
Who is a candidate to receive Medicaid pending home care?
How many hours of home care can someone get Medicaid pending?
When someone is approved for Medicaid, coverage is granted from the beginning of the month in which they applied. For example: If Sally Jones applies for Medicaid on March 14, 2015, and Medicaid approves her application on April 10th, 2015, she will be granted Medicaid coverage for services she received beginning March 1, 2015.
Because Medicaid providers are able to bill for services rendered in the month the application was submitted, some home care providers will render Medicaid level services once a Medicaid application has been submitted (even though it has not yet been approved). This is commonly referred to as “Medicaid pending” home care. However, not every home care provider is a Medicaid provider.
Generally, only a Certified Home Health Agency (CHHA) can approve Medicaid pending home care services. This is because Managed Long-Term Care (MLTC) plans can only enroll someone who already has a Medicaid number and Licensed Home Care Services Agencies (LHCSAs) usually cannot bill Medicaid directly.
If someone would like to receive Medicaid pending home care, the potential provider will likely want to see a copy of the application that was submitted. They may also request proof of submission (such as a stamped transmittal from the Medicaid office). Candidates with higher income face a greater challenge when it comes to being approved for Medicaid pending services. These patients often require a pooled income trust to eliminate their “spend-down”, and it can sometimes take Medicaid months to process these trusts. All the while, providers are not able to bill for at least the amount of the “spend-down”.
Each CHHA will have its own policies regarding Medicaid pending services – some will not provide them at all. If someone would like to receive Medicaid pending services, it can be helpful to obtain the assistance of someone who is familiar with the process. They can help direct them to an agency that provides Medicaid pending services and guide them through the process of obtaining them.
In theory, there should be no difference in the amount of home health care services someone can receive while Medicaid pending from what they can receive with active Medicaid. However, as stated above, only a CHHA can approve Medicaid pending services. We find that people who receive Medicaid level services from a CHHA usually are not approved for more than 8 hours a day, and often substantially less than that.
We provide free assistance for people who are looking to receive Medicaid pending home care. If you would like to obtain Medicaid pending home care for yourself, a loved one, or a client, please give us a call. Call Us Now! 718-838-3838