GuildNet MLTC Closure Update

The New York State Department of Health has affirmed that GuildNet will close as a Managed Long Term Care (MLTC) provider as of January 1, 2019. GuildNet had already ceased MLTC operations on Long Island, so this change primarily affects those in the boroughs of New York City and other parts of the state.

Current GuildNet MLTC clients need to be assessed and select a new MLTC company by December 18, 2018. Please note: if you would like to keep your current home care agency, an MLTC that has a contract with that home care agency MUST be selected.

The new MLTC is required by the state to do the following:

  • Continue to provide services under the enrollee´s existing plan of care, and utilize existing providers, for the earlier of the following: (i) one hundred twenty (120) days after enrollment; or (ii) until the new plan has conducted an assessment and the enrollee has agreed to the new plan of care.
  • Conduct an assessment within 30 days of the transfer enrollment effective date, unless a longer time frame has been expressly authorized by the Department at its sole discretion.

The new MLTC will conduct a new assessment and may recommend changes to the patient’s plan of care. Keep in mind that if you would like to change your new MLTC for any reason (for example, if they want to reduce hours of care), you MUST make that change within the first 90 days.

Click here for additional information: http://www.wnylc.com/health/news/78/

This process can be confusing and overwhelming. Contact Care Answered at 516-584-2007 with any questions or for help selecting a new MLTC agency.

Help with the Juggling Act

Michael Pacella with his youngest grandson, Ryan, his youngest great-grandson, Nolan, and daughter, Linda Wangner

Linda Wangner was in a bind, one that would be familiar to many people struggling to provide care for an elderly loved one while juggling their own lives – living far away, taking care of a spouse with a medical issue, and balancing professional and personal responsibilities.

Linda and her husband live in Arizona part of the year, and Garden City, near her 100-year-old father, the rest of the time. Her father, Michael Pacella, is able to live independently with the help of home health aides. The trouble began a few years ago when she needed to transition from one Managed Long Term Care provider to another. She spent months waiting for an intake interview, only to find that the new agency would only provide aides for eight hours a day, while Mr. Pacella needed round-the-clock care.

At the same time, Linda’s husband underwent surgery that left him immobile during his recuperation. Linda was unable to stay with her father, and unable to care for him in her home while she was on Long Island. During their time in Arizona, Linda teaches part time at the state university, serves on the board of several clubs and helps run her development’s Homeowner’s Association. As the situation in New York deteriorated, she had difficulty carrying out her normal activities due to the stress of constant telephone calls regarding issues with her father’s care. Relief aides failed to show up to take care of him. Others would leave him alone during their shifts. The police would be called, and Mr. Pacella would be taken to a hospital and then discharged to a nursing home until home care could be arranged again.

Then Linda met Nicole Christensen, a healthcare advocate and owner of Care Answered. Nicole met Mr. Pacella and the two hit it off. She was able to persuade him to visit the neurologist, and it was found that he suffered from damage to two areas of his brain that influenced his impulse control and decision making. Care Answered was then able to put in place and coordinate physical therapy at home that helped him do the things he loves.

Nicole was able to transition Mr. Pacella’s care to a new MLTC and home care providers that Linda describes as “light years better than the other agencies.”

As a result, she says, “My Dad has been calmer, easier to get along with.”

Linda has recommended Nicole to many others who are dealing with similar issues.

“Nicole got involved, and life calmed down,” she says. “I had never heard of a patient advocate before, but Nicole could be the poster child for it. She is the best in her field.”

 

 

Medicare Open Enrollment Begins October 15

Monday, October 15 begins the Open Enrollment period for 2019 Medicare. Between October 15 and December 7, you may enroll in Medicare if you became eligible in the past but did not enroll. You may also use this time to make changes to your enrollment. For example, you can switch from traditional Medicare to a Medicare Advantage Plan, change from one Medicare Advantage Plan to another, or change from one prescription drug (Part D) plan to another.

Start by reviewing your coverage. The Medicare website has a host of resources to help you learn more about plans and options so that you can evaluate your needs and select the plan that is best for you. One helpful resource is the Medicare Plan Finder tool which will help you find plans offered in your area.

There will be changes to Medicare beginning in 2019, including elimination of the so-called “donut hole” for prescription drug costs, one year ahead of schedule. Premium rates have not yet been announced, but an increase is projected. Additionally, the income threshold for the highest premium bracket has increased to $500,000 for an individual and $750,000 for a couple, up from $160,000 per individual and $320,000 per married couple.

For additional information or help navigating the complexities of Medicare, don’t be afraid to call on a professional. There are insurance brokers, healthcare advocates and others who can help you sort it all out and select the plans that are most appropriate for your individual situation. Many libraries and community based organizations can connect you with free resources. Want to learn more? Give me a call at 516-584-2007.