Medicaid is a federal and state funded program that provides health coverage to those, including the elderly and disabled, who meet certain income and resource eligibility requirements. Personal care services (PCS), or home attendant services, are provided by a personal care aide to individuals who require nutritional and environmental support as well as assistance with personal care functions. Through New York Medicaid, eligible individuals can receive PCS to maintain their health and safety in their own homes.
What types of personal care services are available through New York Medicaid?
New York Medicaid offers two types of PCS: housekeeping (level 1) or personal care (level 2). Housekeeping PCS is intended for those that are disabled and require assistance with cleaning, grocery shopping, chores, and meal preparation, but do not require help with personal care tasks, such as bathing or dressing. New York State limits the amount of housekeeping PCS to eight hours a week. Personal care PCS includes all of the services covered under housekeeping PCS as well as assistance with personal tasks, including bathing, dressing, grooming, toileting, walking, feeding, administering medication, preparation of meals for special diets, and routine skin care. For bed-bound individuals, turning and positioning is also covered by personal care PCS to prevent bed sores.
Who is eligible for New York Medicaid personal care services?
PCS is restricted to individuals for which the services are deemed medically necessary and whose health and safety can be maintained in the home through the provision of these services. To be eligible for PCS, an individual must be self-directing or have someone available who can direct the care on their behalf. An individual who is responsible for directing the patient’s care does not need to live with them, but they do need to have substantial daily contact.
Also, in order to receive PCS, an individual’s condition must be stable. In other words, a patient’s condition can be degenerative and chronic, but it cannot be expected to suddenly degenerate or improve. A patient’s care cannot require a skilled nurse’s, medical or nursing professional’s judgement to determine changes to the care plan. Finally, an individual’s need for assistance services cannot be met by informal caregivers, formal services, or by specialized or adaptive equipment or supplies, such as a walker or commode. A common reason for PCS denial is that the individual requires a “higher level of care” than what can be provided through personal care.
Are personal care aides the same as home health aides?
Personal care aides differ from home health aides who provide care through Certified Home Health agencies (CHHA). Generally, personal care aides cannot perform “skilled” nursing tasks. In some cases, CHHA home health aides are able to perform care that is semi-skilled, especially if the patient is able to self-direct their care. The certification of CHHA home health aides require that visiting nurses employed by CHHA closely supervise the home health aides.
How can I obtain personal care services through New York Medicaid?
To obtain PCS, an individual must apply and qualify for Community Medicaid. Medicaid recipients, who are under 65 years old and not on Medicare, may request PCS through a mainstream Medicaid managed care plan. These plans will asses the need for services, contract with home care agencies, and authorize services. If a Medicaid recipient is over 18 years, not on Medicare, and not yet enrolled in a mainstream Medicaid managed care plan, they may have the option of enrolling in a Managed Long Term Care plan, through which PCS can be provided. Medicaid recipients who are Medicare beneficiaries and are over 21 years old, must first request a Conflict-Free Eligibility Assessment from NY Medicaid Choice, and then enroll in a Managed Long Term Care plan in order to obtain services.
New York Medicaid provides both health insurance and comprehensive long-term care services to meet the needs of Long Island seniors and ease the burden of caregiving on their loved ones. The professionals at P&P Medicaid & Consulting, Inc. are experienced with handling the entire application and documentation process for New York Medicaid for Nassau County, Suffolk County and Queens residents and will appear on an applicant’s behalf at all interviews with the Department of Social Services (Medicaid). For more information or to schedule a consultation, contact our New York Medicaid application and eligibility office at (516) 541-4770 or fill out our contact form.