Medicaid Home Care Changes on the Way

On or after November 8, 2021, new regulations governing Medicaid home care benefits, including Personal Care Services and Consumer Directed Personal Care Services, will go into effect.

Significant changes to benefits include:

• Routine assessments for home care services are reduced from every 6 months to once a year.
• A physician’s order is no longer required to authorize home care services and the list of qualified practitioners to authorize care has been extended.
• Approval for care over twelve hours per day requires an additional evaluation by a special medical panel to determine if home care services are appropriate to ensure the applicant’s safety in community.
• New applicants must require assistance with at least 3 activities of daily living (ADLs), increased from 2 ADLs. For applicants diagnosed with dementia or Alzheimer’s disease, they must require supervision with at least 2 ADLs to qualify for home care services.

Not all of these new or amended provisions will be implemented at the same time. Additionally, while New York State has cited a start date on or after November 8, 2021 for the above changes, we will continue to monitor any delays due to the COVID-19 pandemic in order to keep you informed.