New York Medicaid Resources:

• State Medicaid Website: New York
• New York Developmental Disabilities Planning Council Website
• The Arc of New York

New York Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 635,500 people with a disability covered by Medicaid in New York. New York spent $28,223 on each Medicaid recipient with a disability in 2007.

13% of all people covered by Medicaid in New York have a disability, while the national percentage of people covered by Medicaid who have a disability is 15%.

New York spends 43% of all the money it spends on Medicaid on services for people with disabilities, while the national percentage of Medicaid spending on these services is 42%.

New York Federal-State Health Reform Partnership (F-SHRP):

This is a pilot program directed specifically at children and adults with disabilities. This program operates statewide and has 6 months of guaranteed eligibility for those who qualify. Some people with disabilities, including those eligible for Medicare, those living in nursing or intermediate care facilities, and children with special needs as defined by the state, are not covered under this program. Available services might be different in different areas.

• Community: transportation
• Health: dental, durable medical equipment, early and periodic screening, diagnosis, and treatment, family planning, hearing, immunization, hospital, mental health, substance abuse treatment, laboratory, occupational therapy, physical therapy, physician services, skilled nursing facilities, speech therapy, vision, x-ray
• Home: home health care
• Social Services: case management

New York Partnership Plan- Family Health Plus:

This program covers all adults who have income and assets at or below the required levels. These levels are higher if you have children, because the state understands that some of your money is spent on your children also. People who are eligible for Medicare do not qualify for this program.

Ages: 19-64

• Community: transportation
• Health: chemical dependence treatment, dental, diabetic supplies and equipment, durable medical equipment, early and periodic screening, diagnosis, and treatment, family planning, hearing, hospice, hospital care, immunization, mental health, substance abuse treatment, laboratory, medically managed detoxification and withdrawal services, pharmacy, physician, radiation therapy, chemotherapy, hemodialysis, smoking cessation, vision, x-ray
• Home: home health care
• Social Services: case management

Managed Long-Term Care Program:

This program covers adults with disabilities, including those participating in HCBS waiver programs, and many people who are also eligible for Medicare. In order to qualify for this program, you must be eligible for placement in a nursing facility, but able to live in the community. Services can be provided to you either at home or at a nursing facility that participates in this plan.

Ages: 18 and older

• Community: adult day care, transportation
• Health: dental, durable medical supplies, hearing, medical social services, nutrition, occupational therapy, personal emergency response systems, physical therapy, podiatry, private-duty nursing, respiratory therapy, skilled nursing facilities, speech pathology, vision
• Home: home health care, personal care, meals
• Social Services: case management

Medicaid Advantage Plus (MAP):

This program is similar to the Managed Long-Term Care Program. It covers adults with disabilities, including some people who are also eligible for Medicare. Like the Managed Long-Term Care Program, enrollees must be eligible for placement in a nursing facility but able to live in the community. Services can be provided in a nursing facility or at home. However, this program does not cover people receiving services through an HCBS waiver program.

Ages: 18 and over

• Community: adult day care, transportation
• Health: dental, durable medical equipment, hearing, meals, medical social services, nutrition, occupational therapy, personal emergency response systems, physical therapy, podiatry, private-duty nursing care, respiratory therapy, skilled nursing facilities, social and environmental supports, speech pathology, vision
• Home: personal care, home health care
• Social Services: case management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Ages: 55 and older

Level of Care: nursing

Restrictions: You must live close enough to an approved center to be eligible.

• Community: day health care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs
• Home: home care, home and environmental modifications
• Social Services: social services

Long-Term Home Health Care Program (Lombardi or Nursing Home without Walls Program):

This waiver applies to older adults or adults who are permanently disabled. It is designed to provide community-based services to people who need nursing care.

Ages: 65 and older for adults with or without disabilities, adults under 65 for people who have permanent disabilities

Level of Care: nursing

Restrictions: certain services are only covered if they are approved.

• Community: medical transportation, social adult day care and transportation
• Health: skilled nursing care, physical and occupational therapy, speech therapy, audiology, respiratory therapy, medical social services, nutrition education and counseling, medical equipment and supplies, personal emergency response systems
• Home: home health services or a personal care aide, housekeeping and homemaking services, home maintenance, respite care, home-delivered or group meals, moving assistance
• Social Services: case management

Traumatic Brain Injury:

This waiver provides services for individuals with brain injuries who want to move into the community or avoid institutionalization.

• Community: structured day services, community integration counseling, community support services, transportation, community transition services
• Health: substance abuse counseling, behavioral interventions and support services, assistive technology
• Home: personal care, respite, environmental modifications, vehicle modifications, housing support

Nursing Home Transition and Diversion Waiver:

This waiver is the newest of New York’s HCBS waivers, and can serve up to 5,000 people. As of 2010, there was room left in the program to serve many more people. This program is designed to help people currently living in nursing homes transition to living in the community, and to help people who are on track to entering nursing homes avoid them.

Ages: 18 and older

• Community: community integration counseling, transitional services, peer mentoring, structured day programs
• Health: assistive technology, nutritional counseling and education, behavioral interventions and supports, respiratory therapy, wellness counseling
• Home: home-delivered or group meals, housing subsidy information, environmental modifications, home visits by medical personnel, independent living skills training, moving assistance, respite
• Social Services: care coordination

Developmental Disabilities waiver (OMRDD waiver):

This waiver is intended to help support people who have developmental disabilities who would otherwise need the care provided in a nursing home or ICF/MR facility. This plan can cover many services not typically provided by Medicaid.

• Health: consolidated support services, adaptive devices, crisis intervention,
• Home: residential habilitation, housing and individual support services, environmental modifications, family support, respite, supportive and supervised residences
• Social Services: service coordination
• Work: supported employment services

Children’s Care at Home (CAH) waiver:

The CAH waiver has two levels: Level I is for children who are physically disabled and require the level of care provided by an intermediate care facility, and Level II is for children who require the level of care provided in a hospital and who are technology dependent. Families with children who meet the criteria but who normally make too much to qualify for Medicaid may be able to participate in this program. Families may apply for this program even if they have insurance from a private provider, since Medicaid may cover services that other insurance does not.

Ages: 18 and under

Level of Care: intermediate (level 1) and nursing/hospital (level 2)

• Home: respite care, home adaptations, vehicle modifications
• Social Services: service coordination

Bridges to Health waiver:

This waiver provides health care to New York State children who are in foster care, and it can follow them after leaving foster care until they turn 21. This waiver provides care for three groups of children: those with developmental disabilities, those with serious emotional disturbances, and those considered medically fragile.

Ages: 21 and under

Restrictions: This waiver is only for children who have been in foster care.

• Community: day habilitation, special needs community advocacy
• Health: health care integration, skill building, crisis avoidance training and management, crisis intervention
• Home: family and caregiver support, respite, in-home supports
• Work: prevocational services, supported employment