Medicaid Home Care: How Many Hours Will Be Approved?

Medicaid Home Care in New York is provided by Managed Long Term Care (MLTC) plans. MLTCs provide Medicaid home care and case management services to people who need long-term care in the community. The MLTC decides how many hours of care you or your loved one will receive and arranges for that care by a network of providers with which the plan contracts.

While there are many MLTC plans to choose from, all plans require an assessment in order to determine the number of hours of care they will provide each day.  This assessment is performed for all new enrollees as well as anyone changing their MLTC provider, such as when a provider exits the market place. 

MLTCs are paid a monthly amount per person (a “capitated rate”) by the New York Medicaid program. Unfortunately, the capitated rate provided by the New York Medicaid program to the MLTCs is the same whether you or your loved one requires 4 hours of daily care or 24 hours of daily care. Therefore, the MLTC is incentivized to provide the least number of hours to you or your loved one in order to increase profitability. 

It is possible to contact more than one MLTC and schedule assessments with each in order to determine the MLTC providing the greatest number of hours. However, you must start this process as soon as possible or there may be a time period whereby the initial limited hours must be accepted before the newly selected MLTC schedules their assessment.

Alternatively, if you are still not satisfied with the determination of hours, a Fair Hearing may be requested.

As always, our Elder Law attorneys are available to answer any questions you may have. Contact us here or call 631.390.5000.