Alert: Nursing Home Medicaid Long-Term Care Disenrollment

January 30, 2020

The Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicaid, recently approved New York State’s request to exclude individuals who have been in a nursing home for more than three months from managed long-term care (MLTC) plans. These plans provide important services for chronically ill or disabled persons. By carving out nursing home benefits from the MLTC benefits package, CMS is reversing a policy that has been in place since 2015.

Advocates fear that MLTC plans will have more incentive to avoid authorizing high hours of home care for those with extensive needs. Before this recent decision, the plan was required to pay the high cost of nursing home care for New York state residents. Therefore, the plan was willing to pay for home care because it often cost less than nursing home care.

Now that the high cost of nursing home care is no longer charged to an MLTC plan, the plan can avoid high costs altogether by denying increased home care services, forcing the member into a nursing home. After three months, the member is disenrolled from the plan. It will become even harder for people with disabilities to stay out of or leave nursing homes.

The knowledgeable New York elder law attorneys at Korsinsky and Klein, LLP regularly handle fair hearings to protect clients who had their approved hours reduced or were denied additional needed service hours. We advocate for seniors to protect their health and safety, leveraging our extensive knowledge of current laws to handle your family’s legal matters with compassion, skill, and patience. If your loved one needs legal protection, do not hesitate to contact us online or call us at 212-495-8133 to set up an initial consultation. We serve clients in Manhattan, Long Island, and Westchester, New York from our offices in Brooklyn, New York, and Lakewood, New Jersey.