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B. MEDICAID

 A program jointly funded by State and Federal government, for the provision of
medical care to eligible, financially disadvantaged people
 Eligibility and coverage criteria vary from state to state

 Eligibility Requirements
 Patient must be a New York resident
 Income and resources must meet established minimums
 Those receiving SSI or Public Assistance are automatically eligible
 Surplus Income Program: if a patient is above the income limit, he/she may still
qualify for Medicaid through various “spend down” programs.

 Medicaid Homecare Criteria
 Same as Medicare criteria, with the following exceptions:
 No homebound requirement
 No skilled/intermittent need requirement
 Broader definition of service, which can include care that prevents
deterioration and maintains function over a long period of time

 Homecare Services reimbursed by Medicaid
 Like Medicare, Medicaid reimburses per episode of care
 Face To Face Encounter form signed by MD
 OPRA enrolled MD
 Services covered are the same as Medicare, with the addition of the following:
 More extensive personal, supportive and custodial care, which can be provided
independent or in conjunction with skilled service
 Home Health Aide (only if this level of care is clinically indicated and
documented), and Home Attendant up to 24 hours/day.
 Housekeeper and Homemaker service
 Prepour and Prefill
 Transportation
 Medications
 Supplies not covered by Medicare, such as diapers, chux (under pads)
 Nutritional supplements (with authorization)

Reimbursement 06-27-2017 Page 3 of 4