Changes to The Medicaid Home Care Program

If one meets certain financial and medical requirements, one can apply for Medicaid to provide home care services.  Such services must be provided by a managed long-term care plan (MLTC) if the individual is:

    1. dual eligible (eligible for both Medicaid and Medicare);
    2. over 21 years of age; and
    3. needs community based long–term care services for more than 120 days.

Since its inception about 5 years ago, there have been various changes to the MLTC program. Here are some recent changes:

Individuals Will Be Locked into Their Plan. An individual who enrolls in an MLTC plan after December 1, 2018, will be given an initial grace period of 90 days in which the individual will be allowed to change plans. After the original 90-day period, the individual will be locked in to the plan for nine months. This does not apply to individuals who were enrolled in an MLTC partial capitation plan prior to December 1, 2018, unless the individual elects to transfer to a new MLTC partial capitation plan. After the initial 90-day grace period, the individual will only be able to disenroll or transfer to another plan if there is good cause. Some examples of good cause are: the enrollee is moving from the plan service area, the plan fails to furnish services or the enrollment in the plan was nonconsensual. After the 9-month period, the individual may enroll in a new MLTC plan.

Involuntary Disenrollment.  If the individual has not received any services from the MLTC in a calendar month, and has not contacted the plan, the enrollee will be involuntarily disenrolled.

Limits Placed on the Number of Home Care Agencies with which an MLTC Plan May Contract. Previously, MLTC plans were able to contract with an unlimited number of licensed home care service agencies. Starting in October 2018, MLTC plans will be limited as to the number of such home care service agencies with which they can contract. In 2019, the number of agencies that the MLTC’s will be able to contract with will be reduced further. This raises concerns with respect to disruption of care. Consumers may lose longtime aides who were employed by an agency that no longer contracts with the MLTC plan. MLTC plans may not have enough home care agencies to staff all their cases. There may be issues finding aides who speak the enrollee’s language and understand the enrollee’s culture.

There is also a two-year moratorium on the approval of new applications to become licensed as a home care agency.

Limit on Marketing by Consumer Directed Personal Assistant Programs (CDPAP). CDPAP agencies must submit any marketing materials to the New York State Department of Health (DOH) for approval. If they publish two or more ads that are “false or misleading,” or not approved by DOH, their license will be revoked. The NYS Consumer Directed Personal Assistance Association is suing New York State, claiming that this requirement violates the first amendment.

This article is based upon an article on the NY Health Access website. The article can be found at http://www.wnylc.com/health/print-news/83/. For those looking to learn more about the Medicaid program, New York Health Access provides very valuable information. New York Health Access is a part of the Western New York Law Center.