Littman Krooks

The federal government’s new guidelines regarding long-term care will have long-lasting impact on seniors throughout New York State. The fed has recently instructed New York to make it mandatory for Medicaid beneficiaries who are 21 years of age and older in need of community-based long-term care services to receive Managed Long Term Care (MLTC).

The mandate also covers New York City residents and seniors with Medicare who have or expect to have home care services. Any seniors who are seeking home care services now have to apply through an approved MLTC vendor for a provider in the network. Prior to the new guidelines, a recipient was able to use any Medicaid-accepting provider.

As part of the change, applications will not be accepted at the Queens local Community Alternative Systems Agency (CASA) offices, a department of the Human Resources Administration for New York City, for Home Care, except in limited cases: Consumer-Directed Personal Assistance Program (CDPAP), Hospice, Traumatic Brain Injury (TBI) Waiver applicants or participants, Nursing Home Transition & Diversion Waiver (NHTDW) applicants or participants, and/or individuals who are  seeking Lombardi (long term home health care waiver program services).

Under the new system, managed care providers get a fee for the bundled services they offer. Critics are concerned that this new system may mean seniors will be forced to change their medical provider to one in the approved system and it may lead the providers to limit the quality of care as a cost-saving measure; seniors may be referred to other services such as nursing homes if it is determined by the managed care provider that home care services would be more expensive than they would prefer. There is growing concern that many seniors may require legal advocacy in order to prevent unwarranted nursing home referrals.

N.Y.C. Medicaid recipients will soon be receiving notification advising them to select a managed care provider within a 60-day window. If they fail to select a managed care provider, one will be chosen on their behalf.

Concerned New York-based seniors may wish to contact an experienced elder law attorney to ensure their healthcare issues are fairly represented and to get up-to-date advice to optimize their Medicaid benefits.