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Ensuring Maximum Hours with MLTC Evaluations

Individuals receiving home care services through a Managed Long Term Care (MLTC) company may find that the agency did not award their family member or loved one with a sufficient amount of hours of home care services after they’ve conducted an evaluation.

The evaluation process by an MLTC can be complex. A person approved for Medicaid Home Care services will eventually have to enroll with an MLTC. The MLTC provider will send an evaluator to assess the recipient’s condition in order to create a care plan that will suit the individual’s daily needs. The evaluator will determine the number of hours per day that the recipient is entitled to receive to assist with their personal care needs. Continue reading “Ensuring Maximum Hours with MLTC Evaluations”

Expect to Pay More for Home Health and Assisted Living Costs

According to the most recent data from the U.S. Census Bureau, there were 2,797,589 people in New York who were aged 65 and over in 2016 which is 14.6% of the state’s population. Compare that number to 2015, when 2,724,135 seniors lived in New York State (14.3% of the population), and 2014 (2,655,913 people ages 65 and over, 14.0% of the population). Continue reading “Expect to Pay More for Home Health and Assisted Living Costs”

Protecting Loved Ones from Elder Abuse

Finding professional and caring home care services for an elderly family member can be challenging.  Families express concerns over the prevention of elder abuse and how they can protect a loved one’s legal rights.  Seeking advice from an experienced elder law attorney can help you make the right decisions when it comes to your elderly loved ones.

Continue reading “Protecting Loved Ones from Elder Abuse”

Medicaid vs. Medicare 101

Although Medicaid and Medicare provide essential services for our loved ones and thousands of Americans, many people either do not know the specifics of each program or simply do not know the difference. Well not anymore! Provided below are the basics everyone should know when dealing with these two aid programs and a basic layout of their differing eligibility requirements, coverage, and funding.

Medicare

Medicare is a federally funded and administered program that provides health insurance for individuals older the age of 65, individuals with disabilities, or individuals with End-Stage Renal Disease (ESRD). Its coverage includes: inpatient services from a hospital or nursing facility, outpatient services, doctor visits, and preventive care, prescription drug costs, or a combination of these services. Most seniors are automatically enrolled when they turn 65, yet those that are disabled are required to contact their local Medicaid office if interested in being enrolled, however cost is not distinguished by qualifying factors but rather is the cost depends on the “level of coverage” assessed.

Medicaid

Medicaid is a federal and state program that is administrated by the state government with the purpose of providing coverage for low-income families. Its coverage includes: hospital and nursing care, certified pediatric and nurse practitioner services, access to federally qualified centers, as well as access to rural health clinic or birth centers licensed by the family’s state. All of those who wish to receive Medicaid benefits must apply within their state office in order to become eligible and costs depend on the income of each family.

Can A Person Qualify for Both Medicare and Medicaid in New York?

Individuals may be dually eligible for both programs. In many of these cases, Medicaid will cover Medicare premiums or co payments for the services covered under Medicare. This allows for effective and comprehensive health coverage.

Contact an Attorney

If you believe you qualify for Medicare or Medicaid and wish to receive benefits, or if you have been previously denied coverage, contact an experienced New York Elder Law Attorney. A skilled attorney can analyze your situation, discuss your options with you, and help ensure your legal rights are protected.

Certified Home Health Agencies not permitted to reduce hours previously authorized without due process

On April 8th  and 15th, 2011,  the State Commissioner of Health sent all CHHA administrators two directives reminding them that state law  does not allow CHHAs to reduce home health aide services that were previously authorized, without doctor’s orders and notice and hearing rights.  Similarly, if a CHHA client is hospitalized, or in temporary short-term rehabilitation, these changes do not allow the CHHA to abandon them — the CHHA must reinstate the same home health services after the hospital or rehab stay is over, if the client continues to need the services as prescribed by his/her treating physician.