Medicaid Home Care Program

When it comes to elder care, residents of New York state have the option of obtaining home care for themselves or a loved one in lieu of seeking nursing home care.

If you have determined that home care is a viable option for you or your loved one, consider using Medicaid to pay for it.

Using Medicaid To Pay For Home Care

Like nursing home care, home care can be paid by Medicaid if the eligibility requirements are satisfied.

Unlike the Medicaid nursing home program, there are no transfer of asset rules for Medicaid home care. In addition, New York's "spousal refusal" law applies. A person can either transfer assets to his or her children, loved ones and/or spouse and obtain home care Medicaid.

A further benefit of Medicaid paid home care versus Medicaid paid nursing home care is that the person applying for Medicaid to pay for in-home care can place his or her income that exceeds the amount permitted by Medicaid into a "pooled trust" administered by a nonprofit. This money can then be used to pay for various living expenses.

Would you like to know more about Medicaid home care? Call the experienced Westchester County, New York, lawyers at Enea, Scanlan & Sirignano, LLP: 914-269-2367. Read Home Is Where The Heart Is: The Medicaid Home Care Alternative...

The Three Categories Of Home Care Services

In New York, Medicaid divides home care services into three main categories:

1. Personal
2. Medical
3. Long-term medical

Personal Care

To receive personal care services, the person's health and safety must be able to be maintained at home. These require the person's medical condition to be "stable," that is, not likely to either deteriorate or improve and does not need medical or nursing advisement to determine changes in the care plan.

Another requirement to qualify under this category is that the person needs some assistance to prevent a health or safety crisis from arising, short of receiving skilled care.

Medicaid further divides personal care into two subcategories:

Level 1: Defined as supplying nutritional and environmental support services, this subcategory includes help with activities such as:

• Making and changing the bed
• Dusting and vacuuming
• Light cleaning of kitchen, bedrooms and bathrooms
• Preparation of simple meals
• Dishwashing
• Shopping and laundry
• Payment of bills and running errands

Level 2: Also known as the "Home Attendant" or "Personal Care" program, Level 2 is a custodial level of care that requires the prior approval of Medicaid. (It is not covered by Medicare.)

Under Level 2, the person requiring care must need assistance with at least two activities of daily living (ADLs).

In addition to providing all of the services under Level 1, Level 2 specifically provides assistance with activities of daily living (ADLs), including:

• Bathing the person in bed, tub or shower
• Dressing or assisting with dressing
• Grooming, including hair care and shaving
• Toileting and toileting assistance
• Assistance with walking
• Assistance with transfer from bed to chair or vice versa
• Preparation of modified diets (low fat, low sugar)
• Administering medication assistance with the use of medical supplies and equipment

In the counties outside of New York City, Level 1 and Level 2 services must be used together. In New York City, they may be used separately.

Medical Care

This program provides skilled nursing care through home health aides. These aides perform a variety of health care tasks under the supervision of a registered nurse or licensed therapist. Home health aides may also assist with personal hygiene, housekeeping and other related supportive tasks.

The tasks that home health aides can perform that personal care aides cannot perform include:
• Preparation of meals following with complex modified diets (only a nurse can add oral medication to food)
• Assist with tube feeding, including the assembly, cleaning and setting up of the equipment
• Monitor the person daily, including taking temperature, listening to heartbeat, taking a pulse, taking blood pressure, weighing and testing for sugar levels in urine
• Apply topical medications

Both Medicare and Medicaid cover this program; the only differences between the two are:
• Medicaid requires these services be provided according to a physician's written plan of care while Medicare does not require this.
• Medicare will only pay for these services for up to 45 days after discharge from a hospital.

Long-Term Care (Lombardi Program)

Unique to New York, the Lombardi program is a Medicaid program that provides long-term skilled care in a home setting. Since the care provided is considered to be equivalent to nursing home care for a person who is chronically ill and who would otherwise qualify for a nursing home, the Lombardi program is aptly referred to as "a nursing home without walls."

The Lombardi program requires the cost of care for the person receiving care not exceed 75 percent of the cost of care in a nursing home.

Under the Lombardi program, the spousal impoverishment rule applies and nursing home budgeting is available. In addition, the spousal refusal law applies and the transfer of assets rule does not.

The services available under the Lombardi program in New York include skilled care, personal care and "waivered" services. The waivered services include:

  • Home maintenance tasks
  • Housing improvement
  • Transportation to social events
  • Respite care
  • Social day care
  • Social work services
  • Respiratory therapy
  • Nutritional counseling

This is but a brief outline of the Lombardi program.

The programs described in this article provide a basic understanding of the home care services available in New York and a starting point for further discussion, as there are many other programs available as well.

Questions About In-Home Care? Call Us.

If you have questions about what is available to you under in-home care, call one of the experienced elder law attorneys at Enea, Scanlan & Sirignano, LLP, in White Plains: 914-269-2367. If you prefer, you may complete this online form.