New York home care programs

Home health: the medical benefit

In New York, skilled home health is Medicaid Home Health Services (Certified Home Health Agency). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with New York Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In New York the agency route is Personal Care Services (PCS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.

Consumer-directed care: the person hires their own aide

New York's consumer-directed option is Consumer Directed Personal Assistance Program (CDPAP) and OPWDD Self-Direction. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Consumer Directed Personal Assistance Program (CDPAP) and OPWDD Self-Direction allow a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

New York has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Consumer Directed Personal Assistance Program (CDPAP) and OPWDD Self-Direction), by the hour, as the participant's chosen aide.

Other ways New York pays for care at home

Waiver in-home services: Children's Waiver, Nursing Home Transition and Diversion Medicaid Waiver (NHTD), and Traumatic Brain Injury Medicaid Waiver. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: Expanded In-home Services for the Elderly Program (EISEP). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Also: Managed Long Term Care (MLTC).

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Medicaid Home Health Services (Certified Home Health Agency)).
• Needs daily help and wants an agency to supply and manage the aide: Personal Care Services (PCS).
• Wants to choose the aide, including a relative where allowed: Consumer Directed Personal Assistance Program (CDPAP) and OPWDD Self-Direction.
• Meets nursing-home level of care and needs more than personal care: Children's Waiver, Nursing Home Transition and Diversion Medicaid Waiver (NHTD), and Traumatic Brain Injury Medicaid Waiver.