HomeFirst Managed Long-Term Care Plan

Care Management

Benefits

• A care manager — usually a nurse or social worker — who builds your care plan with you and your doctor, arranges appointments, and helps coordinate transportation to them.

Coverage

• $ 0 to you. Provided automatically to every member — no prior authorization needed.

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Health Care at Home

Benefits

• Help with everyday activities and skilled care, right where you live. This could include a home health aide, personal care, nursing, physical, occupational, and speech therapy, medical social services, private duty nursing, and respiratory therapy. You can also choose Consumer Directed Personal Assistance Services (CDPAS), where you pick and manage your own aide — even a friend or family member.
• Home-delivered meals and supports such as home maintenance, chore help, and respite care are covered, too.

Coverage

• $0 to you. This is part of what Medicaid calls Long-Term Services and Supports (LTSS). Services must be medically necessary, and your Care Management Team must approve them before you start.

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Support and Care in the Community

Benefits

• Care and connection in your community through two different types of day programs, depending on your clinical and social needs: Adult Day Health Care or Social Day Care Services

Coverage

• $0 to you. Services must be medically necessary and approved before you start. Social Day Care can be part of your care plan, but it cannot be your only service.

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Nursing Home Care

Benefits

• Care in a participating nursing home or skilled nursing facility, including Veterans Home placement for eligible veterans, their spouses, and Gold Star Parents.

Coverage

• $ 0 to you. Covered for permanent placement. Service authorization required. After about three months of permanent placement, care may transition to regular Medicaid.

Medical Equipment & Supplies

Benefits

• Durable medical equipment, medical and surgical supplies, enteral nutrition products, orthotics, prosthetics, orthopedic footwear, and hearing aid batteries.

Coverage

• $0 to you. Covered when medically necessary and authorized by the plan.

Nutrition & Meal Services

Benefits

• Home-delivered or congregate meals (for example, at a senior center) and nutrition assessment and counseling.

Coverage

• $0 to you. For members who are unable to plan, shop for, or prepare meals due to illness, disability, or advanced age. Prior authorization required.

Personal Emergency Response System (PERS)

Benefits

•  An electronic device that lets higher-risk members get help quickly in an emergency.

Coverage

• $0 to you. Service authorization required.

Dental Care

Benefits

• Preventive care such as exams, cleanings, X-rays and essential services such as fillings, crowns, root canals, dentures and more.

Coverage

• $0 to you. Dental services are provided through our in-network partner, DentaQuest. Certain services may require service authorization.

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Vision

Benefits

• Eye exams, eyeglasses, and medically necessary contact lenses.

Coverage

• $0 to you. Covered by HomeFirst through Superior Vision. Routine vision services don’t require authorization.

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Hearing

Benefits

• Audiology exams, hearing aid evaluations, fitting, and repair.

Coverage

• $0 to you. Service authorization required for hearing benefits.

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Foot Care- Podiatry

Benefits

• For medically necessary foot care for conditions like diabetes or ulcers.

Coverage

• $0 to you. Routine hygienic care (such as nail trimming) is not covered without a medical condition; service authorization is required.

Telehealth Services

Benefits

• Care is delivered through secure video and communication technology

Coverage

• $ 0 to you. No service authorization required.