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Medicaid Redesign Team’s Recommendations Lead to Changes in Medicaid Home Care

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On January 5, 2011, Governor Cuomo issued an Executive Order creating the Medicaid Redesign Team (MRT). In February, the Governor chose to accept the recommendations of the MRT and over the next several months New Yorkers will see the results of these recommendations. The first major area of change concentrates on Medicaid coverage of home care services. Nursing Home and Hospital discharge planners need to be aware of these changes as they will undoubtedly have an effect on the care plans created for residents as they leave the facilities.


Housekeeping and Nutritional Services Hours Cuts Effective Immediately


The New York Legislature recently amended a section of the Social Services Law to reduce the maximum number of hours for a Personal Care or CDPAP consumer who requires only Nutritional and Environmental Support Services from twelve (12) to eight (8) hours per week. This amendment goes into effect immediately and case workers have been directed to review all cases exceeding the new limit.


Personal Care Services Part of the Managed Care Benefits Package for Non-Dual-Eligible Recipients of Medicaid Effective August 1, 2011


The New York State Department of Health’s Office of Long Term Care (“OLTC”) recently issued a General Information System Bulletin explaining a new policy, which goes into effect August 1, 2011, that rolls all personal care services, including the accompanying case management services, into the Medicaid Managed Care benefits packages. Any non-dual-eligible Medicaid recipient who receives personal care services must enroll in a Managed Medicaid plan to continue to access these services after their current authorization period ends.


Personal Emergency Response Systems (“PERS”) Part of MCO Benefits Packages Effective January 1, 2012


After January 1, 2012, PERS Units will also become part of the MCO benefits packages.


Consumer Directed Personal Aide Program (“CDPAP”) Services Exempt from Managed Care Requirements for One Year


In July of 2012, the program will start to integrate the Consumer Directed Personal Aide Program (“CDPAP”) into MCO benefits packages as well.


Along with major changes to the administration of Medicaid always come new questions and new issues that will need to be resolved. Please be assured that, if any of these issues impact our clients, Abrams Fensterman will be here to assist. For more information concerning these and other recent changes to the Medicaid rules, please contact Moriah Adamo, Esq., Katie Anne Barbieri, Esq., or your attorney contact at our firm.

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