Community Medicaid: Home Health Aide v. Medical Model Daycare


Question:  “I am considering applying for Community Medicaid for my father, but I am not sure if my mother will accept a home health aide into her home.  What, if anything, could Community Medicaid offer other than a home health aide?”

Answer:  The Community Based (Homecare) Medicaid program can offer alternatives to home health aides; however, you must know the requirements in order to enroll in the program.  Once approved for Community Medicaid, the individual may be enrolled in a Managed Long Term Care Company (MLTC).  The MLTC will be in charge of coordinating the recipient’s healthcare needs including, but not limited to, a home health care aide.

In order to enroll in a MLTC the recipient must either have a home health care aide or be enrolled in a Medical Model Daycare program.  If the family wants a home health care aide, the MLTC will determine the amount of hours per day and days per week that the individual is entitled to have the aide depending on the individual’s need.  The home health care aide can assist with all activities of daily living, including, but not limited to, bathing, grooming, toileting, ambulating, meal preparation, laundry and light housekeeping.  Medical Model Daycare programs offer a place for seniors to go during the day and then return home at night and will provide meals, rehabilitation, monitoring of health conditions and assist with personal hygiene.  Unlike Social Model Daycare, the individual must require assistance with activities of daily living to qualify for Medical Model Daycare.  Once the individual is approved for either a home health aide or Medical Model Daycare, the individual may be enrolled in a MLTC.

The MLTC does offer other benefits including transportation to and from non-emergency medical appointments.  Additionally, the MLTC will also have a network of providers that will accept Medicaid to cover audiology, dentistry, podiatry, optometry, and physical/occupational/speech therapy.  Finally, the individual may also be entitled to medical supplies such as diapers, pull-ups, chux, a wheelchair, walker, hospital bed, and portable ramp, depending on the individual’s need.

Once enrolled in a MLTC the initial evaluation enrolls the individual into a specific plan.  Whether the plan is a home health care aide for a specific number of hours per week or a certain number of days per week attending a Medical Model Daycare or a combination of the two, the plan can always be changed depending on the individual’s needs as time goes on.

In order to get specific eligibility requirements, please see a local elder law expert in your area.

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Burner Law Group, P.C.

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