My father was just approved for Medicaid home care, but they gave him far fewer hours than he really needs. How does New York decide the number of hours, and can we get more?
ProLife best answer
New York decides Medicaid home care hours based on the state assessment, not on what the family asks for. Approvals range from a few hours a week to around-the-clock care.
The number comes from the New York Independent Assessor (NYIA) evaluation: someone who needs help with bathing and meals gets a different number than someone who cannot safely be left alone.
Families are often offered fewer hours than expected, and that number is not final. There are two routes to ask for more:
Both have deadlines printed on the denial or approval notice, so check the dates first. Both turn on the same thing: documentation of what happens during the hours that are not covered (falls, missed meals, nights when he needs help).
If you want a second pair of eyes on the notice, our coordinators can explain what stage you are at and what comes next: (718) 232-2777.
Anna Klyauzova, RN, MSN, MPA · Director of Patient Services, ProLife Home Care
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