Home-Based Health Services
Home Health Care Services
Skilled home health services that Medicare doesn’t cover — including nursing, home health aides, physical therapy, occupational therapy, and speech/language pathology — are delivered in your home. Your doctor writes the plan of care—prior authorization required.
Private Duty Nursing
Medically necessary nursing care by an RN or LPN in your home, following your physician’s or nurse practitioner’s written treatment plan—prior authorization required.
Home-Delivered and Congregate Meals
Hot, nutritious meals delivered to your home, or available at a senior center, for members who can’t safely prepare meals or have them prepared.
Personal Emergency Response Services (PERS)
A small, easy-to-use device — usually worn as a pendant or bracelet — that lets you call for help immediately in a physical, emotional, or environmental emergency.
Social and Environmental Supports
Home maintenance, homemaker and chore services, and respite care for caregivers — items and services that support your medical needs and keep your home livable.
Medical Social Services
A qualified social worker helps you work through social concerns related to your illness, housing, finances, or home environment — so nothing gets in the way of staying safely at home.
Nutrition Services
Assessment of your nutritional status, a tailored nutrition plan, and education from a qualified professional — with your cultural preferences respected.
Prior Authorization for Long-Term Care Services
Most long-term care services — including Personal Care Services, CDPAS, Adult Day Health Care, Social Day Care, Home Health Care, Private Duty Nursing, Nursing Home Care, and DME — require prior authorization. That’s simply our review to confirm that the service meets medical-necessity criteria and aligns with your plan of care.
You don’t have to manage this yourself. Your Care Management Team submits authorization requests on your behalf as part of the process of building and updating your PCSP. For services coordinated directly by your doctor, your doctor’s office handles the submission.
If a service is denied — or approved at a lower level than requested — you have the right to appeal. Your denial notice will explain the reason, the deadline to appeal, and your rights.
→ [Getting Approval for Care] — [Link placeholder] → [Coverage Determinations & Appeals] — [Link placeholder]
Questions About Your Long-Term Care Benefits?
Your Care Management Team is your first call for anything long-term care-related — from adjusting your services to questions about new needs. You can also reach Member Services at any time.
Member Services: 1-877-891-6447 (TTY: 711) Open 8 a.m. – 8 p.m., 7 days a week.
Free, independent help from ICAN (Independent Consumer Advocacy Network):
- Phone: 1-844-614-8800 (TTY: 711), Monday–Friday, 8 a.m.–6 p.m.
- Email: ican@cssny.org
- Web: icannys.org
For the complete legal description of benefits, please see your Evidence of Coverage, Chapter 4, and the Elderplan Plus Long-Term Care Medicaid Member Handbook.