The 30-month financial lookback for Community Medicaid is slated to potentially start October 1, 2022. The changes in qualifying for medical approval for community Medicaid  that we discussed: needing physical assistance with at least three activities of daily living and for those with a dementia diagnosis a minimum of cueing and supervision of at least two activities of daily living physical assistance have been delayed indefinitely.

In Care Answered’s opinion, this is potentially good news and bad news. The good news is that apparently the inability to prepare meals and clean one’s home will still be counted toward medical approval. The potentially bad news is that cueing and supervision will not be considered toward approval or hours of assistance for those with a dementia diagnosis.

May 16, 2022 is still slated for the new Medical Approval process for Community Medicaid. There is more clarity in how the New York Independent Assessment will work logistically. It is not much different then mentioned in previous bogs and webinars. Below is verbatim regarding the New York Independent Assessors from the New York State Department of Health. Contact Care Answered for help navigating Community Medicaid and accessing your best care. 516-584-2007 Ext. 1

What is an assessment?  

An assessment is a meeting between you and a NYIA nurse assessor. The nurse assessor will ask questions to learn about how your care needs affect your daily life. For example, the nurse will ask if you need help getting dressed or bathing. The nurse assessor will ask questions that help determine if you qualify for community based long term services and supports.

Your assessment may take up to three hours. It will take place by video or at your home or where you would receive services. This will allow the nurse to learn what challenges are specific to your living arrangements.

How can I prepare for the assessment?  

It is a good idea to have someone who knows you well at the assessment, such as a family member or caregiver. That person can help you tell the nurse all the tasks you need help with.

You can prepare by thinking about questions you want to ask. And you should have these things ready for the assessment:

  • Some form of identification (ID) (such as a Medicaid card, driver’s license, NY State ID)
  • Your doctor’s name and phone number
  • Your medicine bottles, or a list of the medicines you take and how often
  • Paperwork from a recent doctor’s visit or facility discharge

You can also prepare for your assessment by completing the NYIA Information Sharing Consent Form before your appointment This form gives your health care providers permission to share your health information with the clinician who will conduct your medical exam

On this form, you identify any of your health care providers you want to allow to share information about your health status, including medical records, medications, and treatment plans that might be helpful to the clinician. These health care providers would include your primary care physician and any specialists you see. You must list the name and contact information for at least one health care provider on this form, but you can include as many others as you want.

This form also allows you to name an authorized representative who can act on your behalf in consenting to the release of your health information. Finally, the form allows you to withdraw your consent for any or all of the health care providers you listed when you first completed the form.

You must complete, sign, and submit the NYIA Information Sharing Consent Form online.

What is a clinical appointment?  

Medicaid requires a NYIA clinician to conduct an exam and recommend Medicaid personal care services. We set up a visit with a licensed clinician (physician, nurse practitioner, physician assistant, or specialist assistant) to determine if personal care services are recommended.

The NYIA clinician will ask about your medical history and the medical care you are getting now. The clinician will want to know what help or support you need with your care. If needed, our clinician will talk with your doctor to learn more about your care needs.

After the assessment and clinical visit  

You will get a letter in the mail with your assessment results. If you disagree with the decision, you have the right to a Fair Hearing. The letter has information on how to ask for a Fair Hearing.

Annual assessments 

You must have an assessment every year. This is is to determine if you still qualify for CBLTSS. You will receive a reminder letter when it is time for your annual reassessment.

If you have a major change in your health or life, you may need a new assessment to determine if you still qualify for CBLTSS.

Your local Department of Social Services or your health plan will ask NYIA to rush your assessment.