Things just got tougher for seniors who receive Medicaid Home Care benefits.
Over the past few weeks, there has been a surge in the number of consumers who have been notified by their Managed Long-Term Care (MLTC) plan that their hours of care are being reduced. Families are left floundering -- uncertain about the future and how to provide care for their loved one.
Approval of full time home health care, whether 24/7 live-in care or "split-shift" care, has always been a challenge for individuals seeking assistance. The number of hours to be paid for by Medicaid is determined by the MLTC plan and there is a difference in coverage of care even when it is granted as full time. For example, split-shift care means that two home health aides work twelve-hour shifts each; an aide is always working and on-duty. On the other hand, 24/7 live-in care consists of a single home health aide who works for 13 hours only; that aide is permitted time off to eat meals and to sleep.
Know Your Rights!
If you are notified of a reduction in home care hours, you must request an internal plan appeal through the MLTC before requesting a Fair Hearing. You will have a ten (10) day window to request an internal plan appeal and aid continuing, meaning that you will keep your current services while the appeal is pending. NOTE: The ten (10) day window includes mailing time, weekends and holidays so you MUST read your mail promptly.
An internal plan appeal must be requested via telephone or by fax using an Appeal Request Form. It is imperative that anyone currently receiving services through an MLTC pre-designate someone who may request an internal plan appeal or hearing.
What You Should Do:
Contact us immediately if you or your loved one has Medicaid Home Care benefits and receives notification of a reduction in hours. Our experienced attorneys successfully represent families in the appeal process to ensure continuity of care.