Managed Long Term Care at Home: Proactive Action Required to Expedite Benefits


Managed Long Term Care at Home:  Proactive Action Required to Expedite Benefits

There are two components to a Medicaid Home Care application: the financial eligibility review and the medical assessment to determine the appropriate number of hours of home health aide services. Recent events have led to a dramatic back-log of medical assessments, causing applicants to incur greater out-of-pocket costs. Families need to take action right away to help loved ones secure care at home.

Financial Eligibility:

Unlike Medicaid nursing home benefits, there is no look-back period for Medicaid home care benefits.  As such, an individual can transfer assets immediately and, once below the allowable resource limit of $14,850, be eligible for Medicaid Home Care benefits.  If the applicant has income over the permissible amount of $825/month, the excess income can either be spent on the cost of care or deposited to a Pooled Income Trust. The Medicaid application is submitted to the Department of Social Services documenting financial eligibility. This financial review takes an average of three (3) months from the date the application is submitted.  An individual receiving home care services during this time will typically pay out-of-pocket for those services.

Medical Assessment:

Once the financial approval is secured, a medical assessment is made by the Managed Long Term Care (MLTC) plan to determine the number of hours of home care services needed.  Unfortunately, it is now taking anywhere from 4-6 weeks for the MLTC to perform this assessment.

GuildNet, the MLTC with the largest number of enrollees, has exited the marketplace effective June 1, 2017.  Every individual who was receiving home care services through GuildNet must now enroll in a different MLTC and get a new assessment.  While there are a number of MLTC plans servicing Medicaid recipients, this influx of new enrollees due to GuildNet’s exit has caused a near halt in the scheduling of home care assessments.  Consumers who contact MLTCs will now have to wait as long as 4-6 weeks for an assessment, thereby delaying the start date for Medicaid to cover the cost of care.  For most, this means home care services will be paid for out-of-pocket for a substantial period of time before the Medicaid program engages.

It is more important than ever to apply for Medicaid Home Care services as soon as possible.  For example, if a loved one is hospitalized and you are confident that s/he will require assistance upon returning home, do not wait until s/he is being discharged to begin the process.  The longer you wait, the more out-of-pocket costs will be incurred.
As always, our Elder Law attorneys are available to answer any questions you may have. Contact us here or call 631.390.5000.

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