Homecare Presentation

By: Sofiya Pidzyraylo, LMSW

Agenda

1. What is home care?
2. Who qualifies for home care?
3. Different ways to apply for home care
4. Resources
5. Q&A

What is home care?

Home care is care that allows a person with special needs to stay in their home. It might be for people who are getting older (aging in place). It could also be for people who are chronically ill, recovering from surgery, or have a disability.

Some Activities a person may need help with:

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Activities of Daily Living (ADLs):

• Dressing
• Grooming
• Bathing
• Feeding/ Making Meals
• Using the toilet

Independent Activities of Daily Living (IADLs):

• Housekeeping
• Shopping
• Doing laundry
• Traveling to appointments

Home care services can include:

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• Personal Care I involves help with activities such as housekeeping, cooking, and shopping. These tasks are also called Instrumental Activities of Daily Living (IADLs)
• Personal Care II includes all tasks in Personal Care I plus activities such as bathing, dressing, and grooming. These tasks are also called Activities of Daily Living (ADLs).
• Skilled nursing care, provided by a registered nurse (RNs) and other licensed healthcare professionals in the areas of physical therapy, occupational therapy, and speech therapy to help with rehabilitation, wound care, acute & chronic disease management, etc.

• A PCA (Personal Care Aide) or HHA (Home Health Aide) will come to the home to provide services
• Care can range from a few hours a week to 24 hour care
• Personal Care Aide –
• Helps with daily tasks like personal care and household chores
• Do not administer medical care
• Usually are not bound by strict federal guidelines, so receive less rigorous training
• Home Health Aide –
• Provide more comprehensive care in addition to personal care
• Can handle basic healthcare tasks like measuring vital signs, assisting with medical equipment, and administering medications.
• Undergo a comprehensive training program by approved by DOH to meet qualification

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Ways to get Home Care

1. Private Pay
2. Expanded In-home Services for the Elderly (EISEP)
3. CHAA (Short-term care)
4. Medicaid
5. Private Long Term Care Insurance

Private Pay Homecare

Private Pay Home Care

Home attendant or Personal care services provided through a Licensed Home Care Service Agency (LHCSA) with personal funds.

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• A lot of choice and flexibility to choose from.
• Rates generally start at $36-39/ hour for NYC area
• Visit NYS Health Profiles for a comprehensive list of agencies (you may also google or ask friends who have received similar services)

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EISEP Homecare

Expanded In Home Services for the Elderly

EISEP – Expanded In Home Services for the Elderly

provides coordinated, nonmedical services for older adults who aren’t eligible for Medicaid.

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• Services include Case Management, In Home Assistance, and other ancillary services.
• EISEP does not have fixed, published income limits. However, the program does have cost-sharing rules. Persons whose income exceeds the maximum cost-sharing threshold receive no financial assistance.
• For example, depending on your income hourly rates can range from $0 to $28.50

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EISEP, cont’d

To be eligible:

• Be at least 60 years old
• Need assistance with at least one activity of daily living or two instrumental activities of daily living
• Be able to be maintained safely at home
• Not be eligible for the same services under Medicaid

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To Apply call:

• 1-800-342-9871 (NY Connects) who will then direct you to the correct agency in your area.

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CHHA Homecare – Short Term

Certified Home Health Agency (CHHA)

CHHA Home Care

• Short Term Care – usually means that there was a serious health episode or medical procedure done that necessitated a stay in a hospital or sub-acute rehabilitation care facility.
• Social Worker at hospital or rehab facility will arrange for short term care for the patient
• CHHAs provide a “higher level” of home care, and is most suitable for those with unstable or acute medical conditions, needing close supervision
• A Care Plan will be provided by physician, which may include a nurse, physical/occupational/or speech therapist to provide a skilled service, in addition to a Home Health Aide.
• Patient must be “homebound”

CHHA Home Care

• Medicare
• Medicare will pay only for up to 35 hours a week of home health aide care (though rarely more than 12-20 hours/week)
• With Original Medicare - $0 for covered home health care services
• Pays every 60 days which is called an “episode of care”
• Medicare doesn’t pay for:
• 24-hour-a-day care at home
• Meals delivered to your home
• Homemaker services, like shopping, cleaning, and laundry
• Custodial or personal care like bathing, dressing, and using the bathroom when this is the only care you need
• Medicare Advantage Plan
• Check with your plan about home health care benefits

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Medicaid Homecare

Medicaid Home Care

• Home Care services covered through Medicaid. Services are covered at 100%.
• Medicaid long term care services are usually provided through a private managed long term plan (MLTC)

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• Eligibility for Home Care through Medicaid depends on
• Financial eligibility – meet income and asset guidelines
• Medical Need - must need “physical maneuvering with more than two” ADL’s, or for persons with dementia or Alzheimer's diagnosis, need “at least supervision with more than one ADL.”

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Note for those under 65

• The following process is only for people with Medicare and who are over 65 years old.
• If you have Medicaid but not Medicare, then you generally do not need to enroll in MLTC.
• Your Medicaid Managed Care or HARP plan already covers long term care services.
• Contact Medicaid for more information.

Application Process

Medicaid Eligibility (2025)

• To qualify for homecare through Medicaid, first the consumer must meet income eligibility:

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• Can apply through Access HRA (online) or through local HRA office, if over 65.

Qualifying if over-income

• Medicaid Spend Down (pay-in)
• This program allows you to deduct certain medical expenses– such as bills from doctors’ visits, prescription drugs, over-the-counter medications, or insurance premiums–from your income so that you can qualify for Medicaid.
• Must be 65+
• Have assets below $31,175 for individuals or $42,312 for couples
• Special Needs Pooled Trust
• Enroll excess income in a “Pooled Trust” managed by a non-profit so that the excess income is disregarded in determining Medicaid eligibility. The money they deposit into the pooled income trust remains available to them to pay their bills.
• Medicaid Asset Trust
• If you have excess in assets, you may enroll in a Medicaid Asset Protection Trust, to deposit excess assets. The trust is irrevocable, but you may change beneficiaries.

Medical Necessity

• In order to qualify for Home Care services, consumers must undergo an assessment that determines the type of assistance needed to perform Activities of Daily Living (ADLs)
• This is determined by an assessment through an Independent government assessor – NYIA (New York Independent Assessor Program).
• During the assessment a nurse will interview applicant, ask about performing ADLs in the past 3 days, and consider medical, environmental and social factors.
• To qualify for long term care a person must need assistance with at least 2 Activities of Daily Living (ADLs) for more than 120 days.

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NYIA Process

Appeals

• If you receive a unfavorable determination, you can appeal with a fair hearing.
• Contact ICAN for more information and assistance with Medicaid homecare process

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Resources

• ICAN – Assistance with Medicaid Homecare appeals/questions

ican@cssny.org

844-614-8800

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• NYS Office for the Aging – EISEP questions

NY Connects at 1-800-342-9871.

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• Medicaid Applications – Help through NYLAG

Call 212-613-7310

Mondays 10:00 am – 2:00 pm

EFLRP@nylag.org

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Q&A