When an individual needs help with the activities of daily living, to avoid a nursing home and remain in their residence (whether in Nassau or Suffolk), a benefit worth looking into is Community-based Medicaid. Community Medicaid will pay an agency that will provide home health aides to assist with personal care services in the home.
In previous articles, lists were provided of services and functions that a home health aide can provide. The services provided must be:
1. essential to the maintenance of the enrollee’s health and safety in his or her own home;
2. ordered by a physician or nurse practitioner; and
3. be based on an assessment of the individual’s need for the services.
Additionally, individuals receiving personal care services must have a stable medical condition that is not expected to:
1. exhibit sudden deterioration or improvement; and
2. does not require frequent medical or nursing judgment to determine changes in the patient’s plan of care; and
3. is such that a physically disabled individual is in need of routine supportive assistance and does not need skilled professional care in the home; or
4. the condition is such that a physically disabled or frail elderly individual does not need professional care but does require assistance in the home to prevent a health or safety crisis from developing.
Further, individuals receiving personal care services must be self-directing, meaning an individual is:
1. capable of making choices about his or her activities of daily living;
2. understands the impact(s) of the choice(s); and
3. will assume responsibility for the results of the choices.
Aaron E. Futterman, CPA, Esq. is a partner in the law firm of Futterman & Lanza, LLP with offices in Smithtown, NY and Valley Stream, NY and clients throughout Suffolk, Nassau, Queens, Brooklyn, Bronx, Richmond, New York, Westchester and Rockland Counties. He concentrates his practice to Elder Law, Medicaid Planning, Medicaid Applications, Estate Planning, Probate, Estate Taxes, and Estate Administration.
See “Guidelines for the Provision of Personal Care Services in Medicaid Managed Care” at www.health.ny.gov