Navigating the Medicaid home care process in New York can be overwhelming, with multiple assessments and complex regulations. This complexity makes it crucial to have an experienced advocate or care manager by your side. At our firm, we use a care manager in all our home care cases, and there's a good reason for this. Our clients deserve the best possible care, and having a professional advocate ensures that they receive the services they need.

The Role of an Advocate in Medicaid Home Care Assessments

When applying for Medicaid home care, several assessments are required. Initially, two state assessments are conducted to determine eligibility. For those utilizing the expedited Immediate Needs program, a nurse assessment follows to establish the number of care hours required. Finally, when transitioning into a Managed Long Term Care (MLTC)plan, there is another assessment conducted by the plan.

Each of these assessments is critical in determining the level of care provided, and unfortunately, mistakes or misunderstandings can occur. This is where an advocate or care manager becomes indispensable. They attend all assessment calls, ensuring that everything is documented accurately and that the client's needs are fully represented. Without this advocacy, clients may find themselves underserviced, with fewer care hours than they require.

The Importance of Advocacy During the Transition to Managed Care

One particularly tricky aspect of the process occurs during the transition to managed care. When the time comes to transition an Immediate Needs client to an MLTC plan, the situation can get complicated. Often, the assessor from the plan is unaware that Immediate Needs clients have special transition rights. These rights ensure that clients receive the same level of care with the MLTC as they have been receiving through Immediate Needs. However, without an advocate present, the assessors always try to persuade the client to agree to fewer hours of care. Once a client agrees to this in writing, they lose their transition rights, potentially resulting in a significant reduction in care.

A care manager is there to prevent this from happening. They ensure that the client's rights are upheld and that the level of care remains consistent. This vigilance is vital to protect the client from inadvertently forfeiting their entitlement to necessary services.

Beyond Assessments: Comprehensive Support

In addition to navigating the assessment process, a care manager provides comprehensive support to families. They assist in getting initial care started and help families choose the managed care plan that best fits their needs. This guidance is invaluable in a system that can be both confusing and overwhelming.

Secure the Care You Need

The Medicaid home care process can bed aunting, but you don't have to face it alone. An advocate or care manager can make all the difference, ensuring that your loved one receives the care they deserve. If you're navigating this process, we can help. Click below to get our book describing the Medicaid home care process in detail or call us for a consultation at (718) 740-3300. Let us help you secure the best possible care for your loved one.