This Autumn 2014 marks almost 2 years since implementation of Managed Care by Medicaid in all home-care cases. Most of my clients who already were on home-care services just continued with the same home-health aides and the same number of hours since the change. For new cases, the process of getting onto Medicaid initially has slowed down. Instead of taking 3 months, most new cases are taking in excess of 3 months, up to as long as 6 months for initial approval.
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One factor slowing down the process is the handling of the Special Needs Trust to shelter income. In the past, the trust was not disclosed until Medicaid had approved the case financially and home care was already started. With the new procedure, the trust is presented immediately with the Medicaid application forms. Before the Medicaid application is processed and approved, the trust is sent to the legal unit in Medicaid for approval. Once it comes back approved by the legal unit, the Medicaid worker begins the application approval process. This slows down the entire process by 3 months. It is very disheartening for clients who have minimal assets as the client must spend these assets during the waiting period while their application is being processed. Finally when the Medicaid is approved financially, the client must choose a Managed Care provider for the home health aide to be assigned. The client must accept the number of hours weekly that the Managed Care Agency offers, or else choose another Managed Care Agency to evaluate the hours to be offered. If clients do not feel that the hours offered are sufficient, they can request a Fair Hearing.
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This process halts all services by Medicaid until the decision of an administrative judge. It is the worst possible option for a family to choose. A fair hearing can add an additional 4 to 6 months on the application process. It is better for the client to seek more hours with another Managed Care Agency, or pay privately for the additional hours needed.
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As a final alternative, there is the option of Nursing Home placement. The choice of the Nursing Home is from a list that the client's Managed Care Agency is affiliated with. Once again, if the Nursing Home the client prefers is not part of the list of the client's Managed Care agency, the client can change to a Managed Care agency that is affiliated with the Nursing Home of the client's choice.
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During the entire process and even after the approval and assignment to a Managed Care Agency, our private employment agency offers affordable care to the clients. We have many quality home care workers certified in their fields of study, available on short notice. Our home care is paid $11 hourly, and $143 per day for a 24 hour shift. We charge an 18% agency fee that is billed the following week. All of our workers are screened and carry Malpractice Insurance. Please contact me at Aging Homecare if you need help with caring for a client or loved one. 718-442-2414. We do require a family contract which can be printed out and faxed. Please go to our website AgingHomecare.com. For more information on the social services I provide privately, please visit HollyGemme.com. I hope you enjoy the fall and call if I can be of help.
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Warmly, Holly Gemme