This month, NYC HRA issued a revised M11q Form - the Physician's Order form used to apply for Medicaid personal care (a/k/a home attendant), housekeeping services, or consumer-directed personal assistance program (CDPAP) services. The new form - still called the M11q - is HCSP-M11q (Dec. 9, 2014) and was issued along with tips for completing the form (part of the same document).
- The form has caused confusion because the M11q is no longer used for most applicants for personal care in NYC. Most adults who have Medicare and Medicaid (dual eligibles) are required to enroll in Managed Long Term Care (MLTC) plans to receive personal care or CDPAP services. These plans do not require or use the M11q form.
- Dual eligibles in New York City seeking MLTC services still must apply for Medicaid through the NYC HRA Home Care Services Program, but no longer need to submit the M11q. After their Medicaid is approved, they contact NY Medicaid Choice for a Conflict-Free Eligibility and Enrollment assessment (1-855-222-8350), and then enroll directly in an MLTC plan.
Medicaid applications (not M11q) for people seeking MLTC should be filed at HRA--HCSP Central Medicaid Unit
785 Atlantic Avenue, 7th Floor
Brooklyn, NY 11238 T: 929-221-0849
Who does still need to submit an M11q to HRA Home Care Services Program to apply for personal care, Consumer-Directed Personal Assistance, or Housekeeping?
- HOSPICE - Dual eligibles (people with Medicare and Medicaid) who have Hospice services - are not eligible for MLTC so apply for personal care at HRA Home Care Services Program.
- HOUSEKEEPING - Dual Eligibles who need only HOUSEKEEPING services, limited to only 8 hours per week - these are people who do not need an aide for personal care (dressing, bathing, ambulation) - only for housekeeping (laundry, cleaning, shopping, meal preparation) as a result of disability
- Dual Eligibles under age 21 who need home care
- People with Medicaid only, who do not have Medicare, who are not enrolled in a "mainstream" Medicaid managed care plan. If they are enrolled in such a plan, they should submit an M11q directly to their plan and request the plan to approve home care.
- People enrolled in an OPWDD waiver or the Traumatic Brain Injury (TBI) waiver apply for personal care services through HRA.
Medicaid applications (and the M11q) for people seeking home care who are not eligible for MLTC -- as listed above --should be filed at:
NYC HRA Home Care Services Program
109 East 16th Street, 5th Floor,
New York, NY 10003 TEL 212-824-0706 FAX 212-896-8814
For those who still must file an M11q, use these Q-Tips
as a guide to helping the doctor complete the form.
For those who DON'T need to file an M11q, use the M11q and Q-Tips as a guide for the treating physician to write a statement that lists the individual's diagnoses, medications, need for assistance of an aide, and impairments that impact the ability to perform daily activities. Provide a copy of this statement to the assessor doing the Conflict-Free Eligibility and Enrollment assessment
and also to the MLTC plan at the time of enrollment.