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If you do not already have Medicaid coverage or you have Medicaid coverage that does not include coverage for community-based long term care services, you will need to find out if you are eligible for Medicaid.
If you already have Medicaid coverage: If you already have Medicaid coverage, the first thing you should do is make sure that you are doing everything you need to do to keep your Medicaid coverage. If you are not, find out why. If you think it is because you are not using all of the services you are entitled to, call your Medicaid office and get more help. If you are not getting help, send them the forms listed, above. If you are not getting the right help, you will need to get proof that you are using all the services you are entitled to. If you have questions concerning how to do this, ask your local social services office.
If you already have Medicaid coverage and you are at end of the Medicaid lifetime limit (approximately $160,000 for organic needs and $170,000 for organic needs) or you are being transferred to an HMO: If you have Medicaid and have reached the lifetime limit, your Medicaid will not cover any more home health care services.
If you already have Medicaid coverage and you are being transferred to an HMO: If you already have Medicaid coverage but you are also seeing your HMO or you are going to be assigned a primary care provider, the Medicaid office must give you a letter notifying you that you have been transferred to an HMO or that you are going to be assigned a primary care provider. This letter will tell you whether you would qualify for Medicaid if you put in a request. If you do not qualify for Medicaid (i.e., your needs are not chronic, severe, physical, or cognitive), the Social Security Administration (SSA) will send you a letter telling you that you do not qualify for Medicaid, that your money will come from a different payor, and that home health care is not covered by Medicaid. Your social services office or HRA will give you the IPES numbers or the HRA numbers (Note: Your Social Security office is now actually the HRA) and you will need to ask the primary care provider or the HMO to fill out the "Medicaid Transition Application for Medicaid" form. d2c66b5586
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