The Medicaid application process to obtain coverage for home care used to be far simpler than it is today. In the past, you’d apply for Medicaid with the local agency, it would determine eligibility and what services were needed, and at home care would begin. But in 2012, the rules changed. First, one must apply to the Medicaid agency for financial eligibility and then an evaluation must be done by a Managed Long Term Care Plan (MLTC), which makes the decision on what services will be received. Third, the applicant must go through yet another evaluation to ensure they do need health care services.
It now can take five months or longer for a Medicaid home care applicant to go through what has become a burdensome process freighted with pitfalls. But the delay of care has been compounded by another equally serious matter.
NAELA’s New York chapter presented a report, jointly with Medicaid Matters New York (MMMY) titled Fair Hearing Decisions on Medicaid Home Care Reductions by Managed Long-Term Care Plans June – December 2015, that detailed how seniors are being harmed by this process. The MLTCs are private companies that receive the same payment for services regardless of how many hours of home care services are provided. Along with my colleagues at NAELA, I was concerned these companies would reduce the number of hours of service provided to increase their profits. This is exactly what has happened.
The number of hearings challenging the home care reduction hours from June - December 2015 jumped dramatically: six times the prior year. And in the same time period, most of the proposed reductions came from three MLTC plans: Senior Health Partners, VNSNY Choice and CenterLight (Medicaid Home Care Reduction Report, pages 3 and 4). In fair hearings, the MLTC plans prevailed in only 1.2% (13 out of 1,042) (Medicaid Home Care Reduction Report, page 4). We think that speaks volumes.
MLTC plans are required to give notice to clients before reducing the hours of services, why the services are being reduced and the client’s right to appeal. According to the Medicaid Home Care Reduction Report, most members never received proper notice and many received no notice at all.
Most, if not all, of these clients lack the ability to fight back. They may not understand what it takes to appeal the decisions, and even if they do, they often don’t have the resources to do so. They are elderly, sick and disabled. These are our most vulnerable citizens, and by putting the burden on them to battle an MLTC, we are essentially abandoning them.
If a loved one in your family is not receiving the Medicaid home services they need, having had their services reduced by an MLTC, please call our office to learn how we can help.