Amendments to the law are often necessary to adapt to the growing needs of the community at large. Sometimes change is beneficial. Unfortunately, on occasion change deprives benefits to those who are most vulnerable. Anticipated changes in the New York State Community Medicaid Program (Medicaid home care) promise both the good and the bad in 2023.
Medicaid home care aids those who need personal care assistance, housekeeping, and rehabilitation services to improve or maintain function and/or health. It is designed to provide the services that will allow people to age in their homes. However, it should be remembered that the Medicaid home care program was originally designed to help the needy. Over the years, as our population aged and the cost of health care sky-rocketed, the government has implemented rules and regulations that have allowed the middle-class to gain access to home care benefits through Medicaid planning strategies – often with the assistance of qualified elder law counsel. The legislature continues to respond to the demands on the home care program with regulations that are aimed at balancing the benefits offered with its fiscal requirements. The 2023 changes demonstrate the tension and encompass both increases in one’s ability to financially qualify for the home care benefits and changes to the way in which care will be accessed.
Starting on January 1, 2023, the resource allowance to qualify for Medicaid benefits generally will increase from $16,800 to $28,134 per individual. Couples will be entitled to keep $37,908 of available resources, up from $24,600. Income allowancesarealsoincreasingto $1,563 for individuals and $2,106 for couples. In addition, the State has delayed, until early 2024, the implementation of the look-back period for home care services that was passed in the 2020 budget.
Still, while financial eligibility for home care benefits broadens, access to actual home care services is narrowing. In our last issue, we addressed the impending changes in the assessment process to determine the level of care that Medicaid will provide an applicant. The implementation of the New York Independent Assessors (“NYIA”) program is fully effective December 1, 2022. The practical effect will undoubtedly delay access to care and deny those in the greatest need.
NYIA requires that individuals be evaluated by a state-appointed nurse and clinician. Namely, a medical expert with no prior relationship to the applicant. This two-pronged assessment has led to a delay in approving those in need of home care services. The independent assessor must issue a Practitioner’s Order (“PO”) to certify that the applicant can be safely cared for in the community. Most significantly, if the PO calls for home care services for 12 hours or more a day, a separate Independent Review Panel (“IRP”) must approve the care plan to assure that it is reasonable and appropriate to maintain health and safety in the home. Again, this IRP has no first-hand knowledge of the applicant or their limitations. This multiple-step assessment presents many traps for the unwary.
The need for an advocate through this process is ever increasing. As we approach 2023, it is important to be mindful of these changes and how they might affect you or a loved one. Medicaid planning can be daunting, but it is better to face these changes head-on with a knowledgeable team rather than find yourself ineligible on grounds that could have been mitigated.