What Is a Managed Long Term Care Evaluation?

Question:  My mom has been approved for Community Medicaid and is eligible to receive a personal care aide in her home. I have been trying to schedule an evaluation with a Managed Long Term Care Company but I have been having some difficultly. So far she had one evaluation and she was not awarded sufficient hours. Should I be hiring an attorney to assist with the home evaluation component of Medicaid?

Answer: The home evaluation done by the Managed Long Term Care Company (or “MLTC”) can be a complicated process. It is also the most important as the MLTC will determine the benefits your mother is entitled to through the Medicaid program. Once an individual is financially approved by the local Department of Social Services for Community Medicaid, he or she must enroll with a MLTC. The MLTC will send a nurse to the Medicaid recipient in order to evaluate and create a care plan. The evaluation typically will result in an award of hours to the Medicaid recipient for a home health aide to come to the home and assist the recipient with activities of daily of living. The amount of hours can consist of a few hours per day or live-in care depending on the needs of the Medicaid recipient. If the Medicaid recipient is satisfied with the care plan, he or she may choose to enroll with the MLTC. Otherwise, he or she can request another evaluation with a different MLTC.

Our office determined that our clients were struggling with maximizing the care component at the MLTC evaluations. Community Medicaid is a great benefit, but the client needs to have an appropriate care plan along with sufficient home health care hours in order to ensure their safety and ability to remain at home. At the evaluation, the nurse will ask questions tied to activities of daily living. For example, a typical question may be “is your mother able to use the toilet on her own” or “can your mother prepare meals for herself?” While these questions may seem simple, the answers will generate a certain number of points which will determine the amount of hours she will be entitled to receive through the program.