When an individual needs help with the activities of daily living, to avoid a nursing home and remain in their residence, a benefit worth obtaining 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.
Unfortunately, we are seeing a disturbing trend where clients have been approved by Medicaid, granted Personal Care Services, obtained and received Personal Care Services, and are now being told that their benefits are being reduced. These reductions are often by hours per day and by days per week that aides will be available to the individual. Managed Long Term Care Plans are making determinations to reduce Personal Care Services authorizations.
To combat these reductions in services, you must timely take action. A positive solution in many of these cases is obtained by requesting a Fair Hearing decision. Fair Hearings are quasi-judicial hearings before an Administrative Law Judge. You are able to argue why you think a decision about your case made by Medicaid (your local Department of Social Services) is wrong. Ultimately, a written decision will state whether Medicaid’s (Department of Social Services’) decision was right or wrong. If you are successful, the written decision will order Medicaid (Department of Social Services) to correct your case and keep your Personal Care Services in place with the same number of hours and days available to you.
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.