Medicaid Home Care Changes on the Way

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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.