New York Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

New York provides many long-term care resources for seniors, including those receiving Medicaid for nursing home care and others. For non-medicaid services, NY Connects is a point of entry into the long term services and support system for older adults and people of all ages with disabilities. NY Connects programs are locally based where anyone - individuals, concerned family members or friends, or helping professionals - can go for help in finding the information, services, and supports that they need. To determine where the resources in your community are, you can find information through your local Area Agency on Aging. New York also offers seniors who receive Medicaid benefits many state-run programs for assisted living and in-home care:

Non-Waiver Medicaid Assisted Living and In-Home Care Services

If you are eligible for Medicaid under New York’s Aged (65+), Blind, and Disabled category (ABD), then the following state-run services may be available to assist in your long-term care outside of a nursing home. Medicaid eligibility is determined using certain financial criteria (see below)

Medicaid Eligibility: Medicaid eligibility requirements for long-term care (aged, blind, and disabled) have certain income and asset limits. For 2017, the monthly income limit for seniors over 65 years is $825 and the asset (resource) limit is $14,850 for an individual and $21,750 for a couple. If you are 65 and older and meet these financial criteria the above programs are available to you.

New York State Medicaid Programs

  1. New York also offers seniors who are eligible for long-term Medicaid nursing home care options to stay in Assisted Living facilities, through its Assisted Living Program (ALP). The ALP program serves persons who are medically eligible for nursing home placement but serves them in a less medically intensive, lower cost setting.ALP provides services including: personal care, room, board, housekeeping, supervision, home health aides, personal emergency response services, nursing, physical therapy, occupational therapy, speech therapy, medical supplies and equipment, adult day health care, a range of home health services, and the case management services of a registered professional nurse. To be eligible, both Medicaid recipients and private-payers must be medically eligible for, and would otherwise require, placement in a nursing home due to the lack of a home or suitable home environment. However, eligible ALP residents must not require continual nursing care, be chronically bedfast, or be impaired to the degree that they endanger the safety of other ALP residents. The ALP program is limited to 4,200 residents and approximately 85% are Medicaid recipients. Medicaid recipients must have their ALP services approved in advance by the Local Social Services District.
  2. Medicaid eligible seniors can also access Personal Care Services through the state. The program provides services such as housekeeping, meal preparation, bathing, toileting, and grooming. For Medicaid-eligible persons, local social services districts usually contract with home-care agencies that employ aides to provide Medicaid funded personal care services. To be eligible a participant has his or her doctor send a completed Physician´s Order to the local social services district, which then arranges a social and nursing assessment of the individual. A nurse assessor uses the results of the assessments, together with the physician’s order, to recommend an appropriate amount, frequency and duration of services. If you are eligible and have an immediate need for Personal Care Services, more information is available here.
  3. New York offers the Medicaid Managed Long Term Care (MLTC) through New York Medicaid Choice, a streamlined state program to help with long term care. Managed Long Term Care Planshelp provide services and support to people with a long-lasting health problem or disability. These Plans are approved by the New York State Department of Health to provide Medicaid managed long term care. A Plan can provide your Medicaid home care and other long term care benefits. To get these services, you may be required to join a Plan. A person is required to join the MLTC plan if they meet these three criteria: 1) You have both Medicaid and Medicare; 2) You need home care, adult day health care, or other long term care for more than 120 days (four months); and 3) You are age 21 or older. You can voluntarily join the program if you are eligible for Medicaid and require a nursing home level of care.

Medicaid Waiver Program for Assisted Living and In Home Care

NY Long Term Home Health Care Program (LTHHC) (HCBS LTHHC Medicaid Waiver)

TheLong Term Home Health Care Program (LTHHC) is available to individuals who are medically eligible for placement in a nursing home and choose to receive services at home. These individuals must have care costs which are less than the nursing home cost in the county. The LTHHC program provides a coordinated plan of medical, nursing, and rehabilitative care provided at home to disabled persons who are medically eligible for placement in a nursing home, offering patients an alternative to institutionalization

Services

Services include: respite, assistive technology, community transitional services, congregate and home delivered meals, environmental mods, home and community support services, home maintenance, medical social services, moving assistance, nutritional counseling/education services, respiratory therapy, social day care transportation, social day care

Eligibility

  1. Health: Applicants must require a Nursing Home Level of Care.
  2. Financial: An applicant must meet certain income and asset limits to be eligible for the LTHHC waiver program. For this waiver, the Medicaid financial eligibility criteria is the same as it is for Medicaid for the Aged, Blind, and Disabled. For 2017, this means an individual cannot make more than $825 a month in income, and cannot have more than $14,850 in assets (or $21,750 for a couple). New York allows an applicant who makes too much income to spend down excess monthly income on medical care to become eligible for benefits under the “medically-needy” category. For the non-applicant spouse, they are allowed to keep assets up to $120,900 and a monthly allowance of up to $3,022.50 for expenses (known as the maximum monthly maintenance needs allowance, or MMMNA)

Practical Considerations

The LTHHC is only one of the many possibilities for seniors looking for resources and services to help with long-term care outside of a nursing home facility. While the LTHHC program is a Medicaid waiver, it might not be the best option, as New York operates many state-level programs for assisted living and in-home care that are not part of the waiver program.