Medicaid Letters: CASA Information Sheet

What is CASA?

CASA stands for Community Alternative Systems Agency. CASA makes long-term health care available to low-income individuals in their homes so they do not have to go into a nursing home for care.

How do I apply for CASA services?

 You must be eligible for Medicaid or have a Medicaid application pending in order to qualify for CASA services. If you are presently at home and need CASA services, call the central intake number at 858-2323. A caseworker will fill out an application for you by asking you some questions. Then the caseworker will send you a medical form which you will need to have your doctor fill out and return to the CASA caseworker.

How will I know if I am eligible for CASA services?

 Your doctor must state on the form that you can be maintained at home with the help of Home Care Services. Home Care Services are based on individual needs and may include help with personal care, housekeeping, or home health aides such as a licensed practical nurse. You should also have a family member or a friend willing and available to help you out in case of emergency. You will not be denied CASA services because you do not have an available family member or friend. If your doctor states that you need CASA services, and you are financially eligible, you should receive them.

What if I am in the hospital and find myself in need of CASA services?

 Every hospital has a social worker who can meet with you and make a referral for CASA services for you. A committee made up of the hospital’s health care providers and a caseworker from CASA will work with you and your doctor to determine if you are eligible for CASA services.

What if I am denied CASA services?

 You should receive a notice stating the reason for denial. If you do not receive a notice, but know that you have been denied, call your worker and ask for a written notice of denial.

What if I disagree with the denial?

 Attached to the notice will be a form for requesting a Fair Hearing. Notify OTDA by telephone, fax, or mail that you want a Fair Hearing. You can write on the back of your notice the reason for requesting the hearing. If you phone, get the name of the person you speak to. If you write, send your letter by certified mail and keep a copy. The correct address is:

New York State Office of Temporary and Disability Assistance
Office of Administrative Hearings
P.O. Box 1930
Albany, New York 12201-1930
Telephone No. 1-800-342-3334 or (716) 852-4868
Fax No. (518) 473-6735 (you must have form from Albany)

You should fill out this form and submit it within 60 days of the date of the notice. Then call our office and we will review the denial with you. We will tell you how to challenge it, or we may agree to take your case.

 If you are over 60 years of age, Legal Services for the Elderly may help you prepare for your Fair Hearing. Their number is 853-3087.

What if I am unable to attend the Fair Hearing?

If you are unable to attend the Fair Hearing, you have several options. (1) If transportation is a problem, you can request that special transportation arrangements be made for you. (2) You may appoint someone who knows your situation to appear for you. This person must have written authorization from you and a letter from your doctor stating that you cannot travel. (3) You can request a home hearing. If you request a home hearing, the agency can either decide in your favor or have a hearing by means of a speaker phone. If the agency does not plan to decide in your favor, you are entitled to a home hearing.

If the agency refuses to reverse their decision or to schedule a home hearing, call our office.

 

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