Applying for Medicaid Personal Care Services in New = York City

Applying for Medicaid Personal Care Services in New York=20 City

Category: Medicaid -> Home Care

New York State's Medicaid program covers personal care services, also = known=20 as home attendant services. This is a type of unskilled, custodial = care=20 provided in the home to people with physical or mental impairments that=20 interfere with their ability to independently perform activities of = daily=20 living. This article is about procedures in NYC. See = this=20 article for statewide = information=20 about personal care services.

WHERE TO APPLY - CASA offices are run by = the=20 Medicaid program in NYC. They process both aspects of the=20 application: (1) financial eligibility for Medicaid, and (2) = approval of the personal service based on the doctor's form "M11q" and a = functional assessment, discussed below. If the applicant = for=20 personal care does not yet have Medicaid, they can submit a Medicaid = application=20 to the CASA at the same time as submitting the M-11q. For = more=20 information on Medicaid financial eligibility and applying for home = care, read=20 this memo. See = this=20 information about where to = apply for=20 Medicaid in NYC when you do not want personal care.

HOW TO APPLY. To apply for Medicaid = personal=20 care services, you must submit a form signed by the applicant's = doctor. In=20 New York City, this form is the M-11q Medical Request for = Home=20 Care (April 2010). = Note that=20 the M11q form at this link is a new version that will be effective April = 1,=20 2010. Other than some minor changes regarding the physician's=20 certification, this is the first major revision of the form in more than = 20=20 years. A comparison with the old=20 M11q, effective through April 1, 2010, shows that many of the key = sections=20 of the form have been deleted. The physician is no longer asked to = specify=20 the client's functional limitations, symptoms of mental impairment, = level of=20 continence, or need for specific housekeeping or personal care tasks. =

The M-11q attached to this article is an electronically fillable PDF = form, so=20 you can type your comments into it electronically and print it = out. =20 However, depending up on your software, you may not be able to save the = form=20 with your comments intact. The official = M11q =20 can also be downloaded on the HRA site (not fill-able).

Home care advocates have found that the most effective M-11q forms = are those=20 that have detailed comments about the applicant's impairments and needs = for=20 assistance with activities of daily living. However, the M-11q = form does=20 not have much space for comments, and now the April 2010 form = removes=20 sections that formerly elicited some detailed comments by the = physician. =20 To assist the physician in describing the client's needs, Selfhelp = Community Services, Inc. has created two guides:

Supplement to the = Medical=20 Request for Home Care (M11q) -- Selfhelp has created a = suggested=20 template for additional comments by the treating physician, = tailored for=20 the new 2010 M11q. This supplement should be signed by the = doctor,=20 as is the main M11q. Additional pages can be=20 added.
Q-Tips = -- Helping a=20 doctor to complete the M-11q can be tricky, because the form uses many = terms=20 that are not universally understood by doctors. In addition, = there are=20 some details that are very important to assessing the need for home = care, but=20 which are not solicited on the form. To help you understand how = to=20 complete a successful M-11q, we have written a memo called = Q-Tips. This=20 version has been revised for the April 2010 M11q. The old version of = the =20 Q-Tips memo is also available in Spanish - we hope to update it for = the 2010=20 M11q.. Keep in mind that the M-11q is a medical document -=20 non-doctors can assist in its completion, but in the end, a doctor = must=20 certify that the contents are true.

30-Day Rule and "Stale" M11qs-- = State=20 regulation 505.14(b)(3)=20 requires that the physician complete the physician's order (M11q) within = 30 days=20 of the medical examination of the client, and that the completed M11q be = filed=20 with the local district (CASA) within 30 days of the medical=20 examination. The NYC HRA Home Care Services Program = issued=20 a Memo to all = CASAs, dated=20 May 26, 1995, that clarifies that as long as a signed M11q is submitted = to the=20 CASA within 30 days after the medical examination, it does not=20 become "stale-dated" because it is in the CASA for more than = 30 days=20 without being acted upon. Moreover, this Memo clarifies that = an M11q=20 continues to be valid for one year after the medical=20 examination.

This site provides general = information only.=20 This is not legal advice. You can only obtain legal advice from a = lawyer. In=20 addition, your use of this site does not create an attorney-client=20 relationship. To contact a lawyer, visit http://lawhelp.org/ny. We make every effort to keep these = materials and=20 links up-to-date and in accordance with New York City, New York state = and=20 federal law. However, we do not guarantee the accuracy of this=20 information.

This article was authored by the Evelyn Frank Legal Resources Program = of=20 Selfhelp Community Services, Inc.

Article ID: 34
Last updated: 31 Mar, = 2010
Medicaid=20 -> Home Care -> Applying for Medicaid Personal Care Services in = New York=20 City
http://wnylc.com/health/entry/= 34/