By Nancy Burner, Esq.
The Question: I am considering applying for Community Medicaid for my mom in order to cover the cost of home health aides. I heard that Community Medicaid might pay for certain supplies my mom could use in her home. Is that true?
The Answer: Yes. The Community-Based (Homecare) Medicaid program can assist families in paying for the cost of home health aides as well as other programs, supplies and equipment. Once approved for Community Medicaid, the individual may be enrolled in a Managed Long Term Care Company (MLTC). The MLTC will be in charge of coordinating the recipient’s health care needs including, but not limited to, a home health care aide.
The MLTC will determine the amount of hours per day and days per week that the individual is entitled to have a home health care aide. The determination is based upon the needs of the individual. The home health care aide can assist with all activities of daily living, including but not limited to bathing, grooming, toileting, ambulating, meal preparation, laundry and light housekeeping.
The MLTC will also cover adult day care health programs that offer a place for seniors to go during the day and then return home at night. There are two different options: Medical Model and Social Model. Medical Model will provide meals, rehabilitation, monitoring of health conditions and assist with personal hygiene. Social Model will provide meals, stimulation and senior activities. Some programs will offer transportation to and from the facility. The entire cost of the program, including transportation, will be covered by Community Medicaid.
Another service covered by the MLTC is transportation to and from nonemergency medical appointments. The individual can schedule pick-up at his or her home to any doctor’s office with prior notice. The MLTC will also have a network of providers that will accept Medicaid to cover audiology, dentistry, podiatry, optometry and physical/occupational/speech therapy.
The individual may also be entitled to medical supplies such as diapers, pull-ups, Chux, a wheelchair, walker, hospital bed and portable ramp, depending on the individual’s need. These supplies can be ordered with a prescription from the primary physician. These supplies will be delivered to the home of the Medicaid recipient at no cost.
Finally, certain MLTC providers also offer additional coverage that could be used to pay for premiums, deductibles and other co-pays for medical and prescription drugs. This additional coverage could eliminate the need for supplemental health insurance. It is important to speak with the specific MLTC to find out about what they specifically offer to enrollees.
The Community-Based Medicaid Program is an invaluable program for many seniors who wish to age at home but are unable to do so without some level of care and certain supplies the cost of which would be otherwise too expensive to sustain on their own. In order to get specific eligibility requirements, please see a local elder law expert in your area.
Nancy Burner, Esq. has practiced elder law and estate planning for over 25 years.