Home and Community-Based Service Options for Seniors and Adults With

Home , Assisted living

Home and Community-Based Service Options for Seniors and Adults with Disabilities * October 2018 *This matrix does not include services intended primarily to address the cognitive or behavioral health needs of persons with developmental disabilities, serious mental illness or substance use disorders.

Provider/ Services Eligibility Reimbursement1,2 More Information Program • Skilled nursing • Medical, diagnostic, and social • Medicaid work services • Commercial health • Age 18 or older with a functional impairment. • Medication management, insurance • Chronically ill, frail elderly and disabled adults pharmaceutical review • Long-term care who require certain primary, preventive, • Case and clinical management insurance Adult Day Health Care Council diagnostic, therapeutic, rehabilitative and/or Adult Day Health • Nutrition • Veterans Health Program Locator: www.adhcc.org palliative services. Care (ADHC) • Health Education Administration (VA) • Have a physician's order. • Personal care • Self-pay • Assessed by program and/or managed care • Restorative and maintenance • Some Medicare organization and deemed eligible. physical, occupational, and Advantage plans

speech therapies (beginning 2019) • Therapeutic recreation • Transportation

• Long-term care insurance • Age: • Self-pay LeadingAge NY Provider Locator: o Adult Homes: Age 18 or older; age 16 or • Some accept SSI https://www.leadingageny.org/products- older for public homes. Vast majority of • Medicaid-eligible services/provider- residents are over age 65. individuals may receive locator/?ebizaction=company Adult Care • Room, board, housekeeping, o Enriched Housing: Primarily age 65 or Medicaid-covered Facility (ACF) personal care, supervision and older. home and community- Map of Adult Care Facilities – (includes Adult monitoring • Need supervision and some assistance with based services under searchable by county: Home and • Case management Activities of Daily Living (ADLs)/ Instrumental certain circumstances. http://www.health.ny.gov/facilities/adult_ca Enriched Housing) Activities of Daily Living (IADLs). • Veteran’s pension re/ • Not in need of continual medical or nursing benefits may help to care; medically and mentally appropriate for pay for the services ACFs by Provider Type – adult care facility. provided, if the veteran https://www.health.ny.gov/facilities/adult_c or the veteran spouse are/ meets certain criteria.

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Provider/ Reimbursement1,2 Services Eligibility More Information Program

LeadingAge NY Provider Locator: • Room, board, housekeeping, https://www.leadingageny.org/products- personal care, supervision • Medicaid and SSI services/provider- • Case management • Long-term care locator/?ebizaction=company • Home health care insurance • Medically-eligible for nursing home placement • Personal emergency response • Self-pay Licensed ALPs: • Not in need of continual nursing care, not Assisted Living services • Veteran’s pension https://profiles.health.ny.gov/acf/service/A chronically bedfast, nor impaired to the degree Program (ALP) • Nursing benefits may help to ssisted+Living+Program that the safety of other ALP residents is • Physical, occupational and pay for the services jeopardized. speech therapy provided, if the veteran Local Departments of Social Services • Certain medical supplies and or the veteran spouse web links: equipment meets certain criteria. http://www.health.ny.gov/health_care/med • Adult day health care icaid/ldss.htm

• Long-term care insurance • Room, board, housekeeping, • Need supervision and some assistance with • Self-pay personal care, supervision and ADLs/IADLs. • Some accept SSI LeadingAge NY Provider Locator: Assisted Living monitoring • Basic and SNALR: Not in need of continual • Medicaid-eligible https://www.leadingageny.org/products- Residence, • Case management medical or nursing care; medically and individuals may receive services/provider- including • Enhanced ALRs: Provide mentally appropriate for adult care facility. Medicaid-covered locator/?ebizaction=company Basic Assisted nursing services; additional • EALR only: May accept or retain people home and community- Living Residence services vary whose needs exceed that of an ACF resident. based services under ACFs by Provider Type (includes ALR, (ALR), Special May retain individuals needing 24-hour skilled • Special Needs ALRs: Provide certain circumstances. SNALR, and EALR) – Needs ALR, and nursing care. Retention policies vary. specialized programs and • Veteran’s pension https://profiles.health.ny.gov/acf/service/A Enhanced ALR environmental features for • SNALR only: Requires a specialized benefits may help to dult+Home dementia and other special environment and services to address cognitive pay for the services needs. impairment or dementia. provided, if the veteran or the veteran spouse meets certain criteria.

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Provider/ Services Eligibility Reimbursement1,2 More Information Program

LeadingAge NY Provider Locator: Physician certification of need for one or more of https://www.leadingageny.org/products- the following: skilled nursing care, physical • Medicare • Skilled nursing services/provider- therapy, speech-language pathology services, • Medicaid • Physical, occupational, and locator/?ebizaction=company occupational therapy; and speech therapy • Long-term care Certified Home • For Medicare: Certified as primarily home- insurance NYS Dept. of Health – About CHHAs • Medical social services Health Agency bound with the exception of medical • Commercial health https://profiles.health.ny.gov/home_care/p • Home health aide (CHHA) treatments and infrequent absences for non- insurance ages/chha • Personal care medical reasons. • VA • Nutrition • For Medicaid: No home-bound requirement. • Self-pay Home Care Agencies - searchable by • Medical supplies and appliances • For commercial and long-term care name, type, and county: insurance: Requirements vary. https://profiles.health.ny.gov/home_care/in dex

Vary by county and include: LeadingAge NY Provider Locator: • Case management https://www.leadingageny.org/products- • Personal care services/provider- • Home-delivered meals locator/?ebizaction=company • Information, assistance, referral • Social adult day care NY Connects: Community https://www.nyconnects.ny.gov/ • Transportation • State Office for the Services for the • Respite • New York State resident, age 60 or older Aging block grant plus Elderly Program NYS Office for the Aging: local match (CSE) • Telephone reassurance/visiting http://www.aging.ny.gov/NYSOFA/Progra • Health promotion and wellness ms/CommunityBased/IIIB.cfm • Senior centers • Personal emergency response Local Offices for the Aging: systems http://www.aging.ny.gov/NYSOFA/LocalOf • Minor residential repairs fices.cfm • Escort and other services

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Provider/ Services Eligibility Reimbursement1,2 More Information Program

Must meet all of the following requirements: • Recipient of, or qualify for, community-based Medicaid; • Chronically-ill or physically-disabled, with a Consumer Directed Personal medical need for assistance with Activities of Assistance Association of New York Consumer- Personal assistant may perform Daily Living (ADLs) or self-care tasks or State (CDPAANYS): http://cdpaanys.org/ Directed services that could be provided by Independent Activities of Daily Living (IADLs) Personal a personal care aide, home health and/or skilled nursing tasks; • Medicaid Local Departments of Social Services Assistance aide or a nurse. • Self-directing or have surrogate that can web links: Program manage/coordinate care; http://www.health.ny.gov/health_care/med (CDPAP)3 • Services must be deemed essential to the icaid/ldss.htm maintenance of health and safety in home, as determined by the local social services district, mainstream Medicaid managed care or managed long term care (MLTC) plan.

CCRCs provide independent living, residential amenities, and access • A substantial entrance to a continuum of long term care fee and monthly fees services as residents’ health needs are typically required. change over time. • Life care and modified LeadingAge NY Provider Locator: Generally, must be at least 62 years old and meet contracts guarantee https://www.leadingageny.org/products- Services may include: any health and financial criteria established by the coverage of some or all services/provider- Continuing Care • Meals, social activities, CCRC. assisted living and locator/?ebizaction=company Retirement transportation, housekeeping, skilled nursing services Communities and maintenance while an Prospective CCRC residents must be enrolled in under the monthly fee. New York State Department of Health: (CCRCs) individual resides in the Medicare Part A and Part B and must enroll in and • Some CCRCs offer a https://www.health.ny.gov/facilities/long_te independent housing portion of maintain a Medicare Supplemental Insurance fee-for-service option rm_care/retirement_communities/continui the community; Policy. with monthly fees that ng_care/index.htm • Access to physician, vary based on the prescription drug, and service setting. rehabilitation services; • Medicare covers most • Assisted living services; and medical services. • Skilled nursing care.

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Provider/ Services Eligibility Reimbursement1,2 More Information Program

NYS Office for the Aging https://aging.ny.gov/NYSOFA/Services/In • State and local funding dex.cfm • Case management and non- • Age 60 or older Expanded In- • Clients required to medical in-home services • Need assistance with self-care tasks/ADLs Home Services share in the cost of NY Connects: • Assistance with ADLs and and/or IADLs for the Elderly services according to a https://www.nyconnects.ny.gov/ IADLs • Must not be Medicaid eligible. Program (EISEP) sliding scale based on • Non- institutional respite income. Local Offices for the Aging: http://www.aging.ny.gov/NYSOFA/LocalOf fices.cfm

LeadingAge NY Provider Locator: https://www.leadingageny.org/products- services/provider- • Interdisciplinary, person- locator/?ebizaction=company centered care coordination, nursing and physician services • Medicare: Physician-certified terminal illness Hospice programs - searchable by • Medical social services and with life expectancy of 6 months or less. • Medicare county: counseling (including nutrition • Medicaid: Physician-certified terminal illness • Medicaid https://profiles.health.ny.gov/hospice/coun and bereavement counseling) with life expectancy of 12 months or less. • Commercial health ties_served/ Hospice • Physical, speech and • Commercial health insurance: Requirements insurance occupational therapy vary. • VA Palliative and Hospice providers by • Home health aide and • VA: VA physician-certified terminal illness with • Self-pay county: homemaker services life expectancy of 6 months or less. • Get Palliative Care (CAPC): • Medical supplies and appliances http://www.getpalliativecare.org/ • Short-term inpatient care • Hospice and Palliative Care Association of New York State (HPCANYS): https://www.hpcanys.org/find-care/

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Provider/ Services Eligibility Reimbursement1,2 More Information Program

Independent senior housing may include non-medical services (those not requiring DOH licensure) including, but not limited to: • Dining – full-service dining facility; home-delivered meals including “Meals on Wheels”; on-site amenities such as stores and cafes; and meal preparation Age: • Education/entertainment – • Age requirements vary based on the building’s funding source; range of ages recreational and social • When available, state generally begins at 55 years old. LeadingAge NY Provider Locator: activities; wellness programs; and federal funding https://www.leadingageny.org/products- educational programs; fitness may be used to offset Financial Eligibility for Subsidized Housing: services/provider- centers/activities and social the cost of rent and • Partially determined by geographic location locator/?ebizaction=company day programs allow residents to pay Independent and therefore varies across NYS based on • Resident services – a reduced rent. Senior Housing Area Median Income (AMI) which is updated New York State Homes and Community transportation to shopping, • Self pay for subsidized annually. Renewal: Finding Affordable Housing: appointments and housing is often limited • Also based on the number of apartments set http://www.nyshcr.org/AboutUs/affhsg.htm entertainment; personal to 30% of a tenant’s aside in a particular project for “low” (80% of laundry and linen service; gross income. AMI), “very low” (50% of AMI), and “extremely resident shopping; housekeeping, and light low” (often set at 30% of AMI) income cleaning individuals. • Security/staff – security staff (sometimes on a 24-hour basis); building security features and fire systems

Tenants may also bring in any services that may be provided in a private home (e.g., home care).

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Provider/ Services Eligibility Reimbursement1,2 More Information Program LeadingAge NY Provider Locator: https://www.leadingageny.org/products- • Nursing • Medicaid (through services/provider- • Home health aide contracts with county, locator/?ebizaction=company • Other therapeutic and related CHHAs, and/or services which may include managed care plans) NYS Dept. of Health – About LHCSAs: Licensed Home physical, speech and • Physician must certify a need for LHCSA https://profiles.health.ny.gov/home_care/p • Commercial health Care Service occupational therapy services. ages/lhcsa insurance Agency (LHCSA) • Nutritional services • Requirements vary by payer. • Long-term care LHCSAs- searchable by name, type, • Medical social services insurance and county: • Personal care • VA (housekeeping/IADLs and self- https://profiles.health.ny.gov/home_care/c • Self-pay care tasks/ADLs) ounties_served/type:LHCSA

• Covered services include: LeadingAge NY Provider Locator: o Care management https://www.leadingageny.org/products- o Nursing home services/provider- o Home Care locator/?ebizaction=company o Medicaid Adult Day Health Care Must meet all of the following: Managed Long o DME • Recipient of, or qualify for, Medicaid; About Managed Long Term Care: Term Care o Transportation • Age 18 and older; and • Medicaid http://www.health.ny.gov/health_care/man (MLTC) Plans4,5 o Podiatry aged_care/mltc/aboutmltc.htm o Therapies • Require more than 120 days of community- based long-term care. o Audiology Medicaid Managed Long Term Care o Other long-term services Consumer Guide: and supports. https://nymedicaidchoice.com/sites/default/files/ • Services are generally limited to content-docs/MLTC%20BROCH%20r5-9- network providers. 13%20v4.pdf • Covered service include: o Medicare Parts A, B, and D benefits, including Must meet all of the following: comprehensive inpatient, • Recipient of, or qualify for, Medicaid and Medicaid Managed Long Term Care Medicaid outpatient, physician, post- Medicare; Consumer Guide: Advantage Plus acute, rehabilitative, and • Age 18 and older; • Medicaid and Medicare https://nymedicaidchoice.com/sites/default/files/ (MAP) Plans4,5 pharmacy services. • Require more than 120 days of community- content-docs/MLTC%20BROCH%20r5-9- o Medicaid MLTC benefits based long-term care; 13%20v4.pdf (see above) • Reside in selected plan’s service area. • Services are generally limited to network providers. LeadingAge New York | 13 British American Blvd. Suite 2, Latham, NY 12110 | www.leadingageny.org | Page 7

Provider/ Services Eligibility Reimbursement1,2 More Information Program • Covered services include: o Care management, Must meet all of the following: Medicaid- comprehensive inpatient, • Age 21 and older; This program will expire in December Medicare Fully outpatient, physician, post- • Recipient of, or qualify for, Medicaid and 2019. Integrated Dual acute, rehabilitative, Medicare; Advantage behavioral health, custodial, • Reside in New York City, Westchester or Long • Medicaid and Medicare NYS Dept. of Health – FIDA: (FIDA) Plans4,5 and long-term care and Island; https://www.health.ny.gov/health_care/me supportive services, and • Require more than 120 days of community- dicaid/redesign/fida/ supplies. based long-term care or entering permanent • Services are generally limited to placement in nursing home. network providers.

• Covered services include: o Medicare Part A and Part B services, including post- Medicare.gov: acute care, Must meet all of the following: http://www.medicare.gov/sign-up-change- o Usually Medicare Part D. Medicare • Medicare Part A and Part B beneficiary; plans/medicare-health-plans/medicare- • Generally, do not cover long- Advantage • Reside in service area of the selected plan advantage-plans/medicare-advantage- term care services. Plans4,5 • Do not have End-Stage Renal Disease (except • Medicare plans.html • Special needs plans provide for special needs plans and in limited other specialized coverage for people circumstances). Medicare Plan Finder: with chronic conditions, living in https://www.medicare.gov/find-a- an institution, or with both plan/questions/home.aspx Medicare and Medicaid. • Services are generally limited to network providers.

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Provider/ Services Eligibility Reimbursement1,2 More Information Program LeadingAge NY Provider Locator: https://www.leadingageny.org/products- services/provider-locator/?ebizaction=company • Case management and social Naturally work services. Occurring NYS Office for the Aging: Retirement • Health care management and • NORC-SSP: Reside in an apartment building Classic NORCs: Community prevention programs. or housing complex approved as a NORC. • State and federal funds https://aging.ny.gov/NYSOFA/Services/Cl (NORC), • Home-delivered meals, • NNORC: Reside in a residential dwelling or and grants assic-NORC-Program-Contact- Supportive transportation group of residential dwellings in a • Charitable donations Information.pdf?v=12345 Service Program • Education, socialization, and geographically defined neighborhood • Self-pay (NORC-SSP) and recreational activities. designated as a NORC. Neighborhood NORCs Neighborhood • Volunteer opportunities for https://aging.ny.gov/NYSOFA/Services/N NORC (NNORC) program participants NORC-Program-Contact- Information.pdf?v=23456

• Service Coordination • Assistive Technology • Community Integration Counseling • Community Transition Services • Congregate and Home Delivered Meals Must meet all of the following requirements: • Environmental Modifications • Recipient of Medicaid coverage that supports (home and vehicle) community-based long-term care services; List of NY Regional Resource • Home and Community Supports • Between age 18 and 64 with a physical Development Centers and Specialists: Nursing Home • Medical Home Visits disability, or age 65 and older upon application http://www.health.ny.gov/facilities/long_ter Transition and • Independent Living Skills to the waiver; m_care/waiver/nhtd_manual/section_11/a • Medicaid Diversion (NHTD) Training • Assessed to need a nursing home level of ppendix_g/contact_list.pdf Waiver3 • Moving Assistance care; • Nutritional Counseling • Participant and his/her informal supports work NHTD Housing Subsidy Program: • Peer Mentoring with Regional Resource Development Center http://www.nyshcr.org/Forms/NHTD/ • Positive Behavioral to determine eligibility; Interventions and Supports • Able to live safely in the community. • Respiratory Therapy • Respite • Structured Day Program • Wellness Counseling • Housing subsidy may be available, subject to funding.

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Provider/ Services Eligibility Reimbursement1,2 More Information Program LeadingAge NY Provider Locator: https://www.leadingageny.org/products- services/provider- locator/?ebizaction=company • Health care treatment and supportive services to prevent • Medicare Hospice programs - searchable by or relieve pain and suffering and • Medicaid county: to enhance the patient's quality • Advanced, complex chronic or progressive • Commercial health https://profiles.health.ny.gov/hospice/coun of life. conditions or illnesses requiring pain and insurance ties_served/ Palliative Care • Includes hospice care, but may symptom management and/or assistance with • Long-term care be provided concurrently with ADLs/IADLs. insurance Palliative Care and Hospice Providers- life-prolonging care or as the • VA by county: main focus of care. • Self-pay o Get Palliative Care (CAPC): http://www.getpalliativecare.org/ o Hospice and Palliative Care Association of New York State (HPCANYS): https://www.hpcanys.org/find-care/

LeadingAge NY Provider Locator: • Services include: https://www.leadingageny.org/products- o Care management, services/provider- comprehensive inpatient, locator/?ebizaction=company outpatient, physician, Must meet all of the following requirements: Programs of All- rehabilitative, custodial, and • Nursing home eligible; NYS Dept. of Health Medicaid Managed • Medicaid Inclusive Care long-term care and • Typically, age 55 or older (some programs Long Term Care Guide: • Medicare for the Elderly supportive services, and serve younger members); https://nymedicaidchoice.com/sites/default/files/ 4,5 • Self-pay content-docs/MLTC%20BROCH%20r5-9- (PACE) supplies. • Live within the service area of a PACE; and 13%20v4.pdf • Many services provided in • Able to live safely in the community. PACE centers. National PACE Association Program • Services generally limited to Finder by zip code and state: providers in PACE network. https://www.npaonline.org/pace-you/find- pace-program-your-neighborhood

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Provider/ Services Eligibility Reimbursement1,2 More Information Program Varies depending on respite provider and payer (see NY Connects, managed care plans, and local • Medicaid (through offices for the aging). Eligible individuals for local • NY Connects: managed care plans, office for the aging programs may include: https://www.nyconnects.ny.gov/ waivers, and hospice • Infrequent and temporary • Family caregivers providing care for individuals only) • New York City: substitute care or supervision of age 60 or older. Respite • Medicare (through o NYC Department for the Aging: frail or disabled adults on behalf • Family caregivers providing care for individuals (at person's home hospice benefit) https://a069- of and in the absence of the with Alzheimer's disease and related disorders, or at Adult Care • Long-term care webapps12.nyc.gov/egovt/services/ routine caregiver. regardless of age. Facility, Assisted insurance service_query.cfm • Services vary depending on • Grandparents and other relative caregivers Living Residence • NYSOFA and local respite provider and payer. (not parents) 55 years of age and older or Nursing Home) office for the aging • For other NYS Counties - contact providing care to children under age 18. respite programs local office for the aging: • Grandparents and other relative caregivers • VA http://www.aging.ny.gov/NYSOFA/Loc (not parents) 55 years of age and older. • Self-pay alOffices.cfm providing care to adults age18-59, with

disabilities, to whom they are related by blood, marriage, or adoption.

NY Connects: • Meal and nutrition programs https://www.nyconnects.ny.gov/ • Information and assistance • Health, fitness, and wellness New York City: programs • NYC Department for the Aging: • Transportation services https://a069- • Voluntary client • Public benefits counseling webapps12.nyc.gov/egovt/services/ contributions • Employment assistance service_query.cfm • 60 years of age or older • State, federal and local Senior Center • Volunteer and civic engagement funding • NYCHA Resident's Corner- opportunities • Private donations Senior Centers: • Social and recreational activities http://www.nyc.gov/html/nycha/html • Educational and arts programs /ccschtml/seniorcenters.shtml • Intergenerational programs • Technology For other NYS Counties - contact local • Field Trips office for the aging: http://www.aging.ny.gov/NYSOFA/LocalOf fices.cfm

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Provider/ Services Eligibility Reimbursement1,2 More Information Program LeadingAge NY Provider Locator: Core Services: https://www.leadingageny.org/products- • Socialization services/provider- • Supervision and monitoring locator/?ebizaction=company • Medicaid (through • Personal care • Functionally impaired; needing some MLTC plans only) • Nutrition assistance in at least one ADL (toileting, NY Connects: • Self-pay Social Adult Day mobility, transferring, or eating); or https://www.nyconnects.ny.gov/ • Area Agencies on Care (SADC) Optional services: • Needing supervision due to cognitive and/or Aging grants • Transportation psychosocial impairment. NYS Office for Aging SADS:

• Information and assistance http://www.aging.ny.gov/NYSOFA/Progra • Caregiver assistance ms/CaregiverSvcs/SADS.cfm • Assistance with ADLs

• Service Coordination • Independent Living Skills Training and Development • Structured Day Program Must meet all of the following requirements: • Substance Abuse Program • Recipient of Medicaid coverage that supports • Positive Behavioral community-based long-term care services; Interventions and Support • Diagnosis of traumatic brain injury (TBI); Services List of NY Regional Resource • Between the ages of 18 and 64 upon • Community Integration Development Centers and Specialists: Traumatic Brain application to the waiver; Counseling http://www.health.ny.gov/facilities/long_ter Injury (TBI) • Assessed to need a nursing home level of care • Home and Community Support • Medicaid m_care/waiver/nhtd_manual/section_11/a Waiver3 as a direct result of the TBI; Services ppendix_g/contact_list.pdf • Recipient and his/her personal supports work • Respite Services with Regional Resource Development Center • Environmental Modifications to determine eligibility; Service (vehicles and homes) • Able to live safely in the community. • Assistive Technology Services

• Waiver Transportation • Community Transitional Services • Housing subsidy may be available, subject to funding.

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Provider/ Services Eligibility Reimbursement1,2 More Information Program

Wellness in Local Offices for the Aging: Nutrition (WIN) • Monthly electronic benefits debit Meet certain income guidelines and reside in a http://www.aging.ny.gov/NYSOFA/LocalOf (formerly card to purchase food at household with: fices.cfm Supplemental • Federal and State authorized retail food stores. • an older adult (60+); Nutrition funds. • Home delivered and congregate • a person with a disability; or Eligibility for food assistance program Assistance meals, nutrition-related services. (WIN formerly SNAP): Program or • dependent care expenses. https://mybenefits.ny.gov/ SNAP)

Updated 10/18/18

1 Medicare, Medicaid, and insurance coverage will vary based on the payer, the patient’s/resident’s condition, services needed (e.g., skilled, custodial, or caregiver support) and the duration of services.

2 Veterans with long-term care needs may be eligible for a variety of benefits to help them to address those needs. In addition to VA health benefits, veterans may be eligible for caregiver supports and/or “Aid and Attendance” or “Housebound” benefits. Aid and Attendance is an additional pension benefit for veterans who require assistance with ADLs, live in a nursing home, and/or have extremely poor vision. Similarly, Housebound benefits are additional pension payments for veterans who are substantially confined to their homes.

3 For assistance with the CDPAP, NHTD, and TBI programs and other non-medical services and supports for people with disabilities, independent living centers (ILCs) are an important resource. They provide advocacy and supports to assist people with disabilities to live independently, including information and referrals, peer counseling, individual and systems advocacy, and independent living skills training. They may also provide assistance with housing, education, employment, medical needs and personal attendant services. A directory of ILCs is available at https://www.nysilc.org/resources/ilc- directory.

4 Medicaid Managed Long Term Care Plans, Medicaid Advantage Plus Plans, FIDA Plans, and Medicare Advantage Plans are managed care plans that contract with home and community-based service providers and others to provide care to their enrollees. Managed care plans do not directly provide services other than care management, although some plans are sponsored by organizations that are also health care providers. PACE programs, by contrast, operate as both managed care plans and providers of services. Typically, if a consumer is enrolled in one of these plans/programs, the plan or program must authorize the delivery of home and community-based services. Beginning in 2019, some Medicare Advantage Plans will be authorized to offer limited long-term services and supports.

5 Individuals with both Medicare and Medicaid coverage who do not need long-term care services may qualify for Medicaid Advantage plans.

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