Medicaid Programs for New York Seniors – Eligibility & How to Apply

Medicaid Programs for New York Seniors

In This Report:

1. OVERVIEW – MEDICAID AND NEW YORK’S ELDERLY
2. MANAGED LONG-TERM CARE (MLTC) – NY
3. CONSUMER DIRECTED PERSONAL ASSISTANCE PROGRAM (CDPAP)
4. WHO IS ELIGIBLE FOR MLTC PLANS IN NY?
5. HOW TO APPLY FOR MLTC PLANS IN NY
6. NYS MLTC HELPLINES

1. Overview – Medicaid and NY’s Elderly

While Medicaid programs target different groups of people, this report is concerned only with long-term care that benefits the elderly, with a focus on the state of New York.
Medicaid is a joint venture between the Federal government and each state, catering mostly to low-income people. The Federal government provides subsidies and sets basic standards while, generally speaking, each state sets eligibility requirements and other rules that govern services. Some 73 million people received Medicaid benefits in 2016, making it the largest payer of healthcare benefits in the United States.

Here is a brief summary of the type of elderly-related programs that Medicaid offers in the state of New York:

• Nursing homes: If you are a Medicaid beneficiary, Medicaid has traditionally paid for long-term care in all Medicaid-certified nursing homes.
• Home-based programs: For at-home care, Medicaid has several programs in the state of New York that cover home health care (skilled nursing, short-term care) as well as personal care (assistance with daily life tasks – non-medical, long-term care).

Home and community-based programs: In 2017, every state in the country, as well as D.C., offered at least one program that pays for elderly-related services for those who choose not to become nursing home residents. The state of New York has various programs (that will be discussed in detail in subsequent sections) that provide assistance at home, in assisted living facilities (ALFs), in day care, and with other home-related chores.

2. Managed Long-Term Care (MLTC) – NY

Whether for at-home care, day care, or community-based facilities, the New York State Department of Health offers several programs, referred to as Medicaid managed long-term care (MLTC) plans, that assist, among other demographics, the elderly community.

Here are the basic elements of such plans:

Network of providers: When you become a plan beneficiary, you get all services from a specified network of providers. These networks include skilled nursing home health agencies, non-medical home care agencies, and various healthcare professionals and other providers.

Plan of Care and Care Manager: When you join a plan, a Care Manager will help you (and members of your family) develop your own Plan of Care from among the following three different types:

• MLTC Medicaid Plan: This offers only Medicaid services, typically chosen by people who need home or other long-term care services (day care, specialty care and other services) but are happy with existing arrangements for doctors and other Medicare-type services.
• Medicaid Advantage Plus: This offers Medicaid and Medicare services, typically selected by individuals who want to combine all long-term care services under one plan.
• Program for All-Inclusive Care for the Elderly (PACE): You can join PACE if you are 55 or older, typically selected by people who get all their health-related services at home or in day care centers from the provider network assigned to them.
• Consumer Directed Personal Assistance Program (CDPAP): This is discussed separately in a subsequent section.

Two other less referred-to plans are FIDA (Medicare Advantage + MLTC) and Medicaid Advantage Plan.

Mandates to join a plan: If you are 21 or over, a beneficiary of both Medicare and Medicaid, and in need of long-term care (defined as 120 days or longer), then you are mandated to join one of the three types of plans. You can choose to join one of the Medicaid plans where you live, but you can switch plans if you choose at any point later on. In addition, if you already have home care services, the plan you choose will first approve a set of services for you, and then will take over.

Plan services: Each of the three plan types provide:    

• At-home or community-based long-term care
• Other health-related services such as medications, supplies, and equipment
• In addition, some plans offer Medicare-type services like visits to physician and hospital care

How to choose a plan and enroll: If you need assistance choosing and/or enrolling in a plan, you may wish to contact a New York Medicaid Choice counselor at 1-888-401- 6582 (TTY: 1-888-329-1541).

You will subsequently receive a confirmation letter from New York Medicaid Choice that gives you:

• A Member Handbook
• A starting date for your plan
• A Plan Identification card

3. Consumer Directed Personal Assistance Program (CDPAP):

The CDPAP program is tailor-made for:

• NY-State’s elderly community and Medicaid beneficiaries
• Individuals who receive either at-home skilled nursing home health services, or at-home non-medical long-term care
• And those who prefer to manage their own personal assistance care

CDPAP allows such individuals, together with those who support them at home, to hire, manage, supervise, and fire caregivers at their own discretion.

The program commonly appeals to individuals who receive at-home assistance with their activities of daily living (ADLs), including, for example, grooming, bathing, dressing, eating, and other ADLs. When they hire their own caregivers (typically loved ones or friend), they get the opportunity to train them to their specific needs, while Medicaid, through the CDPAP Program, covers all caregiver-related expenses.

Because the CDPAP program allows you to include family and friends among the caregivers that the program covers, it is among the few programs nationwide that financially reward some of the 40 million family caregivers who devote their lives and leave their jobs and other sources of income in order to care for a loved one at home.

In addition, parents of disabled children over the age of 21 can thus become the paid caregivers as long as:

• They are not the “legal representative” of the care recipient (as defined by the Department of Health)
• And the level and amount of care needed by the recipient justify the hiring of a family or professional caregiver

Finally, if you have an immediate and urgent need for at-home care services, you may have your application processed more quickly if:

• You are not already receiving care from a home care or home health agency
• You have no family or friendly caregivers who can come to your assistance or continue providing your needed care
• You don’t possess an insurance policy that can pay for your at-home care
• You are not qualified to receive Medicare-type at-home services (these would mostly be for skilled nursing or home health services)
• You do not already possess at-home adaptive equipment that meets your needs

4. Who Is Eligible for MLTC Plans in NYS?

You are eligible for applying for an MLTC plan if you:

• Are 21 or older and reside in an area serviced by your chosen plan
• Need at-home services that are commonly provided in nursing home settings
• Can safely remain at home
• Are certifiably in need of long-term care, i.e. longer than 120 days (this is demonstrated using a form filled out by your doctor)
• Are willing to be serviced by the plan’s network of providers

5. How to Apply for MLTC Plans in New York

The first step in enrolling is to contact your chosen plan administrators who will send a counselor to your home to conduct a preliminary needs assessment. Needless to say, you can also recruit the help of a certified counselor on your own, someone who will stay with you until you are completely set up with your plan.

The government’s counselor would have the initial tasks to:

• Set up a Care Plan that meets your specific needs
• Help you secure necessary health-related documents from doctors, laboratories, and other previous professional providers
• Assist you in choosing a plan
• Familiarizing you and your support people at home with your chosen plan
• Help you with completing the plan’s application questionnaire and agreement
• Help you choose a set of providers from among the plan’s provider network
• And answer any remaining questions you or your support people at home may have

6. NYS MLTC Helplines

Although understanding and then applying to an MLTC plan may at first seem daunting, The NY State Department of Health goes out of its way to make the process more readily accessible to those who qualify.

Here are links that may prove useful at the start for choosing and then applying to a plan:

This link will take you to the government’s “choosing a health plan” official guide.

The NY State Department of Health (The government’s Health Plan Marketplace).

This link will take you to the government’s complete MLTC guide.

Contact information for regional MLTC guides.

To reach your plan administrators, this link provides plan contact information in the various boroughs and cities in the State of New York.

This link will take you to certified MLTC counselors.

If you have urgent needs (as discussed in the CDPAP section), you may find this link helpful for your immediate needs.

This link is for NYS’s Department of Health “pharmacy benefit information” center

This link will also take you to a list of frequently asked questions and answers (FAQs) in regard to managed long-term care.

This “paying for health care” guide includes information on Medicare, Medicaid, MLTC and other long-term care payers.

Good luck with your MLTC plan!