26 NOVEMBER 17 - NOVEMBER 23, 2017 BROOKLYN MEDIA GROUP
THE ELDER LAW MINUTE TM
BY RONALD A. FATOULLAH, ESQ. & STACEY MESHNICK, ESQ. Navigating the Medicaid home care system
Recently, it has become increasingly
difficult for those in need to obtain
24-hour home care, especially split
shift care (two 12-hour shifts).
It is unclear how New York State
will be able to sustain the Medicaid
home care program with the move in
recent years to managed long term
care (MLTC), which is essentially
an HMO model (Medicaid pays the
agencies the same monthly amount
per recipient whether they provide
four hours per day or 24 hours per
day) and with the current challenges
to wage and hour laws for home care
workers.
If an individual is already receiving
care and the hours are reduced,
he or she must be provided with written
notice as to the reduction and the
reason for such reduction.
There are methods to appeal this
decision. The individual can initiate
an internal appeal and request a reevaluation.
However, it is important
simultaneously to request a Medicaid
fair hearing with “Aid Continuing”
within 10 days of the decision.
If the commissioner of the Department
of Health grants the request
for Aid Continuing, Medicaid must
continue to provide services to the
individual at the same level at which
he or she was previously awarded
until such time as a “Decision After
Fair Hearing” is issued.
In order to receive the necessary
care, it is important to know what
needs to be demonstrated to the
agency evaluating the number of
hours that will be provided. A common
misconception is that services
are based on the diagnoses of the
Medicaid recipient.
In fact, hours are awarded based
on the extent to which the Medicaid
recipient requires assistance with
his or her Activities of Daily Living
(ADLs). Therefore, during an evaluation,
it is important to educate the
evaluating nurse on which ADLs
the Medicaid recipient requires
assistance with and the frequency of
such need. The ADLs that typically
result in a higher award of hours
tend to be ambulation/transfers and
toileting.
It is important for a Medicaid recipient
to offer concrete evidence of his
or her needs. In addition to specifying
the activity, the frequency of the need
must be addressed, such as the recipient
requiring assistance with going
to the bathroom several times during
the night.
If an individual must attend a fair
hearing, he or she should bring any
documents supporting the need for
increased care. Such documents include
doctors’ recommendations and
an Affirmation from a doctor, medical
records, evaluations performed by
disinterested parties, and a witness,
such as an aide.
Personal care services must be authorized
in amounts that are medically
necessary. While there are specific
standards for determining the need
for 24-hour care, the regulations are
not as specific for people who require
less than 24-hour care.
Local Medicaid programs as well
as managed care and MLTC plans
that authorize personal care aides
are permitted to use assessment
tools that may not result in receiving
the number of hours actually
needed.
Ronald A. Fatoullah, Esq. is the principal
of Ronald Fatoullah & Associates,
a law firm that concentrates in elder
law, estate planning, Medicaid planning,
guardianships, estate administration,
trusts, wills, and real estate.
Stacey Meshnick, Esq. is a senior staff
attorney at the firm who has chaired
the firm’s Medicaid department for
over 15 years. The law firm can be
reached at 718-261-1700, 516-466-
4422, or toll free at 1-877-ELDER-LAW
or 1-877-ESTATES. Mr. Fatoullah is
also a partner with Advice Period, a
wealth management firm, and he can
be reached at 424-256-7273.
If you rode
the original,
you’re ready for
AgeWell New York.
THE WAY TO AGE WELL
IN NEW YORK
Personalized, easy to understand,
easy to live with Medicare
Advantage Prescription Drug Plans
$0 or low cost Plan Premiums
agewellnewyork.com
718-696-0206
TTY/TDD 800-662-1220
AgeWell New York, LLC is a HMO plan with Medicare and Medicaid contracts. Enrollment in AgeWell New York, LLC depends on contract renewal. This
information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits,
premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Premiums, copays, coinsurance
and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. AgeWell New York complies with applicable
Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AgeWell New York complies with applicable Federal
civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AgeWell New York cumple con las leyes federales de
derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. AgeWell New York 遵守適用的聯邦民權法
律規定,不因 種族、膚色、民族血統、年齡、殘障或 別而歧視任何人。ATTENTION: If you do not speak English, language assistance services,
free of charge, are available to you. Call 1-866-586-8044 (TTY: 1-800-662-1220). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de
asistencia lingüística. Llame al 1-866-586-8044 (TTY: 1-800-662-1220). 注意:如果您使用繁體中文,您可以免費獲得語言援 助服務。請致電
1-866-586-8044 (TTY: 1-800-662-1220). H4922_PCyclone4002 Accepted 09192017