Managed Medicaid Home Care

New York State has a new managed Medicaid Long Term Care Plan (MLTC). Under this program, the State of New York pays for long-term care of an individual in a community setting. This generally refers to paying for home care for someone living at home. A healthcare aide or personal care aide helps take care of this individual in his or her residence.  This program does not involve a “fee for service” payment arrangement.

Under the Medicaid paid managed long term care program, Medicaid pays a home care agency, which acts as the Medicaid provider, a specific fixed monthly amount for each person in the program. The same amount is paid without regard to the services actually provided.

There are currently two types of programs available in the State of New York. The first program is called Paid All-inclusive Care for the Elderly (PACE). The second program is called Medicaid Managed Long Term Care plan (MMLTC). The eligibility requirements for each of these programs are exactly the same.

Eligibility For Managed Medicaid Home Care Programs

The current eligibility requirement is $14,400 in assets. In addition an individual going into the program can have $800 per month in income. To get into the program, the perspective applicant must prove that his or her total assets are not greater than the $14,400.  Excluded from the assets test is the value of the primary residence, personal property and a car. In the event the individual applying for the program has income greater than $800 per month, he or she must either spend down the excess on expenses related to their care or enter into a pooled trust. In cases where the proposed plan participant is married, the total income for the family is $1,175 a month and total assets is $21,150. It should be noted there is no penalty for the transfer of assets that exists for filing for Institutional Medicaid benefits and there is no five year look back period.

About The Author

Elliot S. Schlissel, Esq. is a member of the National Academy of Elder Law attorneys and works with clients with regard to all Medicaid planning matters as well as elder care and trusts and estates related matters.