Beyond Medicaid is an informational blog post that is part of a series based on my own experience with programs for individuals who need additional personal care assistance at home beyond Medicare and Medicaid.
For people like myself living in Nassau County, Long Island, New York who have qualified for and receive Medicaid through the Nassau County Social Services Department(1) but still need additional services or services beyond Long Island continue with additional services below.
In fact, these are outside of the range of what I refer to as plain ‘vanilla’ Medicaid. In order to proceed, the next step is to contact a ‘Simplified Medicare Agent’. I have had wonderful success with the person at the footnote below.(2)
Moving Along For my complex needs, I was assigned an agency care coordinator who navigated me through the ‘Baskin Robins’ flavors (as I call them) programs beyond Medicaid. This is exactly where the Beyond Medicaid extra help process got down to specifics for me. So let’s continue with the details.
The Central Nassau Guidance & Counseling Services
Central Nassau Guidance Services(3)
These are the step-by-step instructions for application and approved programs that I got assistance in my quest for extra help.
For example, the agency I get help from is Central Nassau Guidance Services. With the help of this organization, I have a care coordinator who guides and assists me with many personal and home care needs.
The New York Independent Assessor Application(4)
The next step in applying for extra help known as Medicaid Managed Long Term Care (MMLTC) is to contact the the New York Independent Assessor (NYIA). This process includes both phone and in-person interviews. If one qualifies, there are many services available.
But they are not as well known as programs like SNAP (food stamps) or as straight forward to receive. So it is very helpful if not essential to have a care coordinator to help one translate and navigate through the applications, then choose the assistance that may become available. When I started this whole dizzying process, it felt like a dictionary of foreign codes to me.
Medicaid Managed Long Term Care Program(5)
Medicaid Managed Long Term Care is the overall program you want to qualify for. It has a bounty of services with a variety of levels of home based care that may become available to an individual like myself who qualifies. Here’s what happened next for me.
Centers Plan for healthy Living Logo
Centers Plan for Healthy Living(6)
MMLTC is a program but not a place with public access. Therefore there are organizations that provide the next stage of service. One such organization is the Centers Plan for Health Living.
Through this organization, I have a care manager who oversees the care I get. In addition, she monitors my condition with a questionnaire to evaluate if I need more medical care or other services.
Current Assistance For now, there are primarily two categories of care in which I get supplementation. They are personal care and nutritional care. Each of these areas is overseen by the Centers Plan for Healthy Living but dispensed by independent agencies. In actuality, personal care is through the Cottage Home Care while nutrition is supplied by Mom’s Meals.
Cottage Home Care(7)This is a company that supplies home care aids to individuals who cannot manage completely on their own. Assistance ranges from a few hours a week to full time home care assistance. Meal preparation, personal hygiene, food shopping, laundry and light housekeeping can be included.
The Mom’s Meals logo
Mom’s Meals(8)This is a company that offers prepared meals delivered on a weekly basis. The number of meals provided is determined by the number of hours an individual receives in extra care to compensate for the need to prepare one’s own meals. In other words if an aid is available in the morning for 3.5/hrs per day 3 days a week, the aid can prepare breakfast 3 times per week.
Since I need help with breakfasts on the four other days and main meals every day, the total need for meal supplementation is eleven meals which are provided to me at no charge. I have found these to be a tremendous help. In fact, there are many meal choices to select from. The food is decent as well. All that is necessary is a short microwave warm up.
Conclusion This blog post, Beyond Medicaid may not answer all your questions about this topic. But it should cut down dramatically on the research you might have to do for getting extra help while you are still able to live at home. When you have to move on to assisted living or a nursing home, you will need other information. These are topics for future posts.
The NYS Social Services System has inconsistencies that can make financial security very challenging. For someone not familiar with this system, it might not make any sense. In fact, that is because it is not sensible.
Nassau County Department of Social Services
A Closed System
Social Services is a closed system. In other words if one area increases, another area will decrease rather than also increase. For example, when there is a COLA (cost of living) increase in monthly social security payments, food stamp payments will decrease.
Logic would dictate that if the cost of living increases, the cost of food also increases. But the closed system concludes that if an individual receives a greater social security payment, there is less need for assistance with food purchases.
Another example is that increases to income through other sources and benefits can lessen if not eliminate ones eligibility for food stamps. In other words, it can best to get a direct increase in food stamps rather than an increase in monthly income.
In addition, if an individual’s income increase is great enough, one can lose Medicaid benefits. That can result in a loss of coverage for medical expenses that are covered under Medicaid. Medicaid coverage is substantially greater than Medicare coverage. Therefore if one needs financial assistance from the social services system, it is better to qualify for more help rather than less help.
New York State Local Social Services Departments
The Inconsistencies
Because of the inconsistencies within the social services system, it is important to learn how it works. A good place to start is with a social worker at a community senior center. Actually these professionals often schedule visits to senior residential facilities offering their services at no cost.
The NYC Department of Social Services
In addition, counties have facilities where individuals can learn about and apply for financial assistance. To find one, check on Google. In the Sources & Resources section below are links to several social services departments. They include New York State and counties within it.
This post was originally written before The Trump Administration came into power. One of their campaign promises was to repeal and replace Obamacare. At this time, it is not known what the outcome will be. But an article in TalkPoverty.com indicates that a completely new plan could decimate Medicaid for seniors and people with disabilities.
The Healthcare Insurance Crisis
There is a Poor Middle Class healthcare insurance crisis in this country. In fact, this issue is of growing concern. The lack of sufficient medical care coverage for many people is the cause. The cost for others is also of great concern. The deepest concern is felt by the poor and poor middle class. Here’s the reason. With the election of the new President, the Obamacare Program was promised to be discarded and replaced. But now in spite of that promise, no one knows what would or could replace it.
At present closer examination, lawmakers see that Obamacare will not be so easy to repeal and replace. Instead of such an extreme measure, they are suggesting that refinement may be a more reasonable solution. But with the new President, this could be even more of a challenge. The reason is that he is not in favor of compromise. He would rather make a sweeping changes. That would mean erasing the blackboard and starting over from scratch. According to the map in Figure 1 below, Affordable Care Act Medicaid Expansion could be in jeopardy. This could impact healthcare negatively for many people.
Figure 1: Expansion states are split between Republican and Democratic governors as of January 2017.
Medicare and Medicaid
Essentially, the differences between Medicare and Medicaid is fairly straightforward. In other words, eligibility for Medicare is at age 62. Contrary to Medicare, Medicaid benefits are based on financial need and disabilities rather than by age. In addition, individuals above a certain income level pay a monthly premium for Medicare. Not only that, they have a co-pay for medical services. On the other hand, Medicaid recipients do not have a co-pay. Let’s go to Wikipedia for more thorough definitions of Medicare and Medicaid.
Figure 2: Medicaid eligibility increased for parents and other adults in expansion states under the ACA.
The Wikipedia definitions for Medicare and Medicaid
Definition of Medicare According to WikipediaMedicare card and Medicaid logo samplesDefinition of Medicaid According to Wkikpedia
Figure 3: Most of the growth in Medicaid enrollment was in expansion states and the West from Summer 2013 to September 2016.
The Prospects for Poor Middle Class Healthcare
There are added benefits to Medicaid over Medicare. Therefore, maintaining Medicaid is a major concern for poor middle class people’s health care insurance. Individuals on Medicaid have:
• a zero monthly premium
• 100% coverage for primary medical care
• referred coverage at no charge
• minimal charge for prescriptions
Figure 4: About 11 million Medicaid enrollees in 2015 were newly eligible adults in the expansion group.
What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion?
The article begins: What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion? Dec 06, 2016 | Robin Rudowitz, Samantha Artiga, and Katherine Young
Figure 5: Uninsured rate drops more between 2013 and 2016 in states that adopted the Medicaid expansion.
This article concludes: What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion? Dec 06, 2016 | Robin Rudowitz, Samantha Artiga, and Katherine Young
Figure 6: From January 2014 – June 2015, spending for the expansion group totaled $84 billion ($79 billion in federal funds).
