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Battles Continue Over New Medicaid Eligibility for NY Home Health Programs

In an effort to more efficiently use state funds, over the past few years the New York Medicaid program has been closely analyzed by state groups looking to root out fraud. Those investigations have returned hundreds of millions of dollars back into the programs following problematic practices at New York nursing homes, senior day care facilities, and many other settings.

While rooting out excess and fraud is a net positive, one must not forget the real lives that are affected any time that changes are demanded by program officials. Many New York seniors are in delicate situations, and any time that a nursing home, at-home provider, or other entity is no longer able to operate as a result of bad practices, many seniors struggle to deal with caregiving changes.

Finding Good Elderly Home Care in New York
For that reason, it is important to make prudent choices about elder caregiving from the outset to increase the chance that the service will be available indefinitely, providing quality support and stability for seniors. Most appreciate the need to be diligent when selecting a nursing home, but the same rules apply when deciding upon at-home caregivers and related service providers.

This week the New York Times published a story on the current disagreement regarding at-home caregiving companies (CHAAs – certified home health agencies) qualified by the New York Medicaid program.

In particular, the report details how two companies which were previously hit with charges of Medicaid fraud (resulting in multi-million dollar settlements) are now once again listed as a agencies participating in NY long-term care programs supported by Medicaid.

It remains unclear what changes were made by the entities which allowed them to return to the good graces of those making applications decisions. Expectedly, concerns have been raised about undue political influence playing a role, but all those involved are denying such claims. In addition, state officials point out that the previous problems were rooted in issues with the “pay per service” model then used. Now, following drastic re-vamping to the New York long-term care program, the services operate on a managed-care system, with a set fee paid per month regardless of the care provided. The idea is that the new model will save costs while still ensuring that quality care is provided.

In any event, it is worth browsing the entire NYT article to get a better feel for some of the basics of the home health care portion of the NY Medicaid system and the issues being debated.

Feel free to contact our NY Medicaid lawyers for helping dealing with the confusing administrative details of securing coverage and finding an appropriate care setting for your loved one.

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