DAL 14-22: Adult Home Case Management
October 7, 2014
DAL: DAL 14-22
Subject: Adult Home Case Management
Dear Adult Home Administrator and Case Manager:
Regulations governing the operation of Adult Care Facilities (ACFs) are found under Title 18 of the New York Code of Rules and Regulations (NYCRR) and require the provision of case management services (18NYCRR 487.7 (g) and 488.7 (e)). Case management services must include assisting residents in need of alternative living arrangements to develop and execute a sound discharge plan. Case management services also must include assisting residents in making application for, and maintaining income entitlements and public benefits.
This letter is intended to provide information which may be helpful when assisting your ACF residents who desire to transition from the ACF to another setting, do not currently have Medicaid insurance, and residents who are required to maintain Medicaid Excess Income program eligibility (also known as Spend Down or Surplus Income) for Medicaid purposes.
Case managers must assist residents desiring to transition to the community by assembling all the necessary documentation. This includes at a minimum:
- A copy of the Social Security Administration (SSA) award letter(s);
- A copy of the resident's Benefit Card and/or Medicaid card and/or any other insurance cards;
- A picture (I.D.) card; and
- A copy of the completed Medical Evaluation form DSS-3122
For residents who are not currently enrolled in Medicaid, please review the eligibility requirements found at the NYS Department of Health link below:
http://www.health.ny.gov/health_care/medicaid/#qualify
For residents who may not meet Medicaid's eligibility requirements, the New York Legal Assistance Group's (NYLAG) link below provides guidance titled, "How to Get Medicaid Despite Having Excess Income:"
http://www.wnylc.com/health/afile/6/4/
It is the Adult Home case manager's responsibility to assist each resident in applying for public benefits.
The Medicaid Excess Income Program is one way for certain applicants to qualify for Medicaid even though their income and/or assets may be over the financial limit. The program does so by offsetting the excess income with medical expenses. The following NYS Department of Health link provides an explanation of the Medicaid Excess Income Program:
http://www.health.ny.gov/health_care/medicaid/publications/docs/adm/11adm-2att3.pdf
Case managers are responsible for assisting residents in maintaining their Medicaid eligibility by assisting them in meeting their excess income eligibility requirements. The following Department of Health link provides answers to various questions related to the Medicaid Excess Income Program:
http://www.health.ny.gov/health_care/medicaid/excess_income.htm#how
Residents interested in eliminating the Medicaid Spend Down may also consider applying for a Special Needs Trust. The NYLAG link below provides a step-by-step guide instructing how to apply for the trust:
http://www.wnylc.com/health/entry/44/
Lastly, case managers provide an important service for ACF residents. Resident entitlements should be reviewed as needed but at least annually. Please share this valuable information with your case managers.
Questions regarding Medicaid should be directed to the Medicaid Helpline at 1- (800) 541-2831.
Sincerely,
Valerie A. Deetz
Division of ACF and Assisted Living Surveillance
And the Community Transitions Program
