The application for Medicaid Home Care Services is Just the Beginning

New Jersey Medicaid has a program to deliver home and community-based services to people who meet the “institutional level of care” but would be able to remain at home as long as they receive an array of long term services and supports (LTSS). Examples of LTSS are: bathing, grocery shopping, meal preparation, feeding, dressing, safety supervision, and hands-on help with transferring or walking. Within the Medicaid system (called “MLTSS”), services are now delivered through HMO’s that have contracts with the State of New Jersey.

Once your Medicaid application is approved, you receive a Medicaid number. Next, you will be asked to select an HMO. Each county has just a few – presently they are Horizon, WellGroup, Aetna, United Health and Ameri-Group. Next, your case will be referred to the HMO to assign a Care Manager, who will come to the home and put together a Care Plan. The HMO will use a tool to assign minutes or hours per day for different services to be performed (such as 15 minutes for a bath). Here is the tool issued by the State.PCA assessment tool A given HMO may also use its own proprietary analytic tool. In other posts I’ve written about how important it is to advocate for the highest level of need and care possible. This is true at the initial clinical assessment and at the stage we are talking about here. The Care Manager should not be permitted to assume that volunteer care providers from the family or neighborhood are available to continue volunteering.

The Care Plan is then coordinated with the Office of Community Choice Options (OCCO). Once the plan is written up, though, a snag can occur. Read my next post to see more about that.

For legal advice on Medicaid applications, eligibility and appeals, call us at 732-382-6070


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