by Ronald Fatoullah and Stacey Meshnick
In 2020, the Social Services Law and Public Health Law were amended to change the assessment eligibility criteria for Medicaid recipients seeking Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS), as well as those seeking enrollment in a Managed Long-Term Care (MLTC) plan. The change implements Minimum Needs Requirements for individuals being initially assessed for home care using the Community Health Assessment beginning September 1, 2025.
Minimum Needs Requirements is the new eligibility determination that requires individuals to be assessed on their ability to perform Activities of Daily Living (ADLs). ADLs are fundamental self-care tasks that individuals need to perform independently to live on their own. ADLs are crucial for assessing a person’s functional ability and determining the need for assistance or support. The most fundamental self-care tasks or ADLs include:
Bathing/Showering: Cleaning oneself in a bath or shower.
Dressing: Selecting and putting on clothes.
Toileting: Getting to and from the toilet, using it correctly, and cleaning up.
Transferring/Mobility: Moving between surfaces, such as bed to chair or wheelchair.
Continence: Controlling bladder and bowel functions.
Feeding: Getting food from a plate to the mouth and consuming it.
Ambulation: The ability to walk or move around.
Eligibility requires that the applicant needs community-based long-term care services for over 120 days and must meet at least one of the following: 1) limited assistance with physical maneuvering with three or more ADLs; or 2) for individuals with dementia or an Alzheimer’s diagnosis, the applicant must need supervision with two or more ADLs. Individuals assessed for PCS/CDPAS under the new Minimum Needs Requirements with a diagnosis of Alzheimer’s disease or dementia must also provide proof of such diagnosis during the assessment process.
Individuals who have met any of the following criteria before September 1, 2025 are grandfathered in and will not be subject to the new ADL thresholds (Legacy Status):
1. Individuals already enrolled in PCS/CDPAS/MLTC prior to September 1, 2025;
2. Individuals assessed by the New York Independent Assessor between September 1, 2024 and September 1, 2025, who then enroll or are authorized within 12 months;
3. Individuals who have an initial assessment scheduled before September 1, 2025, which appointment is rescheduled through no fault of their own to a date after September 1, 2025. The rescheduling must occur before the date of the initial scheduled appointment.
If PCS/CDPAS is indicated to be appropriate after assessment, the local Department of Social Services (LDSS) will complete the care plan process, develop the plan of care, authorize services, and notify the individual using the appropriate Notice of Decision or Notice of Intent. When an individual’s assessment indicates they do not meet the Minimum Needs Requirements, the outcome notice will provide that information and include fair hearing rights. In this instance, no action or Notice of Intent is required by the LDSS.
Given the new harsher Medicaid requirements, it is now more important than ever to retain an elder law attorney to protect assets and to manage and supervise the Medicaid application process. The attorneys in the Elder Law Practice Group at Meltzer, Lippe, Goldstein & Breitstone, LLP are available to assist in managing every aspect of the complex Medicaid application process.
Ronald Fatoullah, Esq. Chairs the firm’s Elder Law Practice Group and is a Partner of the firm’s Trusts & Estates Practice Group. Stacey Meshnick, Esq. is a member of the firm’s Trusts & Estates and Elder Law Practice Groups.
This blog posting is for informational and educational purposes only. It is general in nature and not person or circumstance specific. This blog posting is not intended, nor should it be construed as rendering independent investment, legal or tax advice. It may but does not necessarily constitute attorney advertising.