Evaluation Time: Have An Advocate Present

A home evaluation is conducted by a Managed Long Term Care Company (MLTCC) after an individual has been approved for Community Medicaid by the Department of Social Services. The evaluation process can be complex and may result in difficulty due to the MLTCC failing to award a Medicaid recipient with sufficient hours. An evaluation by a MLTCC is extremely important, because it is the determining factor for which benefits a recipient is entitled to through the Medicaid program

A nurse is sent to the recipient’s home to evaluate his or her needs and establish a long-term care plan. The long-term care plan will include the number of hours awarded to the recipient for a home health aide to assist the Medicaid recipient with daily tasks. The amount of hours awarded can range from a few hours per day to a live in home health care aide. Once an individual is satisfied with the long-term care plan, he or she may enroll with the MLTCC. If an individual is not satisfied with the long-term care plan, he or she may request an evaluation with a different MLTCC.

During the evaluation, a series of points are generated based upon the answers provided to questions that are asked by the evaluating nurse. The nurse may ask questions such as “does the recipient use the toilet alone or take a bath alone.” The points awarded determine the number of hours of care that an individual will receive through the Medicaid program.

An attorney may assist with a home evaluation component to help maximize the care component. A sufficient long-term care plan ensures that an aging person is safe while he or she remains in their home. An attorney or another advocate is entitled to attend the evaluation by the MLTCC. A local expert can assist in stressing the importance of maximizing the hours for an aging individual to the evaluating nurse.

Having an advocate attend the evaluation and communicate with the MLTC to maximize hours can be an invaluable component of the Community Medicaid process. If you are a family member or loved one and are having trouble receiving an appropriate or adequate long-term care plan, contact an elder law attorney who can assist you in receiving the care you need.

The New Jersey Medicaid planning attorneys at Hunziker, Jones and Sweeney, P.A. can answer your questions about planning for Medicaid, and assist you along the way. For more information or to schedule a consultation, call our New Jersey Medicaid planning law firm at (973) 256-0456 or fill out our contact form.

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