Long Term Care at Home - Additional Medicaid Programs

 In a previous article I discussed the traditional home-care Medicaid program – aides who help with activities of daily living, and the financial qualifications for home-care Medicaid coverage in general.

            In addition to traditional home care, several other programs are available and paid for by Medicaid. They include, for example, medical model adult day care. Often located in a nursing home, this program usually provides door-to-door transportation, a cooked meal, socialization, trained supervision and assistance with bathing. Also available typically is a higher level of skilled care than most home attendants can provide, including physical therapy, management of medications and access to additional services by medical professionals. 

           Social model day care, also available, can be important for someone who is blind, memory-impaired or otherwise isolated, but who has no need for skilled medical care. 

            The Long-Term Home Health Care Program, also known as the “Lombardi Program,” provides nursing home level of services in the home. The estimated cost of care cannot exceed 75% of Medicaid’s cost to care for the recipient in a skilled nursing facility. 

            For those who are eligible for nursing home level of care, but are capable of safely living at home with assistance (such as the visually impaired and those with multiple disabilities), certain managed care organizations, such as GuildNet, can be employed to coordinate a full range of home health care services.   

            The Consumer Directed Personal Assistance Program (CDPAP) allows you or your family to take responsibility for hiring, training, supervising and firing, if necessary, the caregiver paid by Medicaid. A primary advantage to this program is that the aide can perform tasks that a Medicaid agency personal care aide is not authorized to perform, such as administering medications. The CDPAP agency handles all paychecks and financial record keeping. This program has become especially important for those who would like to keep the private caregiver they have, but would like Medicaid to pay for at least some of the cost of care.

Next year New York State’s Medicaid program is scheduled to be converted to a managed care system, where private companies are contracted to provide case management and coordinate long term care services. Those who are on Medicaid can expect to receive a letter stating that they need to choose a managed care organization. Exactly how well this will work remains to be seen.  

Copyright 2011 Joseph A. Bollhofer, Esq.

Editor’s Note:

Joseph A. Bollhofer, Esq., is an attorney who practices law in the areas of elder law, Medicaid, estate and business planning and administration, real estate and personal injury. He is a member of the National Academy of Elder Law Attorneys (NAELA) and of the Elder Law, Real Property, and Surrogate’s Court Committees of the Suffolk County Bar Association and  the Elder Law, Real Property Law and Torts, Insurance and Negligence Sections of the New York State Bar Association. He has been serving area residents since 1985 and is admitted to practice law in New York and New Jersey. His office is located at 291 Lake Ave., St. James, NY. (631-584-0100). For reprints of this article and others send a request to info@bollhoferlaw.com or visit www.bollhoferlaw.com.