Home Health
Home Health is the delivery of skilled nursing, therapy and other assistive healthcare services in the home, following a hospital stay, preventing a hospital visit, or extending care ordinarily provided within a facility into the community.
Home Health services are typically provided for a limited period of time, such as 60 days.
In New York State, agencies that provide Home Health are called Certified Home Health Agencies (CHHAs), licensed under Article 36 of the Public Health Law. These agencies are reimbursed by Medicare, Medicaid, managed care, and commercial insurance.
Some private insurers may include coverage for home care. However, the majority of services are covered by Medicare and Medicaid, which have specific eligibility requirements and some limitations on coverage. For instance, Medicare, the program for individuals 65 and older, requires a patient to be “homebound” and need at least one skilled service. Medicare coverage is typically for care that is intermittent or shorter in duration. Medicaid does provide long-term assistive services but coverage is income-dependent and most recipients need to enroll into a Managed Long Term Care (MLTC) plan first before obtaining services. New York State law has begun a process of transitioning most of the Medicaid long term care services into a form of managed care.
Personal Care
Personal care services offer assistance with Activities of Daily Living (ADLs), such as personal hygiene, mobility, toileting, feeding, meal preparation, housekeeping and laundry for people who require such support services based on a medical need.
These are services provided by home health aides and personal care aides, employed by Licensed Home Care Services Agencies (LHCSAs) or directly selected by the patient as part of the Consumer Directed Personal Assistance Program (CDPAP), through Managed Long Term Care plans that manage these patients and the expenditure of the Medicaid funds that pay for this care.
Hospice
Hospice is the delivery of services for individuals who are terminally ill, and their families. Rather than treatment, hospice services focus on easing symptoms at the end of life.
Hospice can be paid for by Medicaid, Medicare, some commercial insurance, and private pay for individuals who have a prognosis of less than 6 months to live. It can include nursing and medical services, supplies, therapies, and counseling. Home health aide and supports are also available.
Care Management
Many of the state’s Medicaid home care services now require recipients to enroll into Managed Long Term Care plans, which have home care agencies and other providers within their networks to deliver services (providers in an MLTC network may include CHHAs, LHCSAs, LTHHCPs and others). If a patient is Medicaid-eligible and is in need of long term care, he or she may be required to first enroll into an MLTC depending on what region of the state or type of service is needed.
