Home Care Work: Covering the People Who Do the Covering

Three arrangements that look like one job

A licensed home care agency. The agency is the employer. Hours, assignments and payroll come from it, and if there is a health plan it comes from it too.

CDPAP, the Consumer Directed Personal Assistance Program. The person receiving care hires and directs their own aide; payroll runs through a fiscal intermediary. The administration of this changed with the move to a statewide intermediary, so the entity issuing the paycheck is not what it was a few years ago. How CDPAP works now.

Directly for a family, with no agency and no program in between. In the state’s terms that makes you a domestic worker in a private household, and a specific set of thresholds applies.

Knowing which one you are in answers most of the rest, and it is worth being able to say out loud.

If there is a union fund

Where there is one — 1199SEIU is the largest in this field — the structure is usually two layers, and treating them as one is why benefits go unused.

The medical plan covers the network, hospitals and specialists. The welfare fund separately administers dental, optical and prescription benefits, often with its own phone number and its own claim forms.

The question that recovers the most unclaimed benefit, asked of the fund:

“What does the fund cover that the medical plan does not, and how do I claim it?”

Eligibility in these funds is frequently tied to hours worked in a period, which means a quiet month can affect coverage two months later. Ask what the threshold is and how it is measured before it becomes a problem. What to check in a 1199SEIU plan.

When there is no plan at all

Which is the common case, and New York’s answer is better than the national one:

The Essential Plan — $0 a month at or below 200% of the federal poverty level, no deductible, no enrollment season. A very large share of home care workers sit inside that line. What it covers.

Medicaid at lower income, year-round. Child Health Plus for children, reaching far above what parents expect and regardless of the child’s immigration status.

NYC Care where status puts insurance out of reach: no status requirement, no income cutoff for membership. How it works.

Paid partly or wholly in cash? Not an obstacle. New York accepts an attestation of income checked against data. How that works.

The injury question, which lands hard in this job

Lifting injuries, back injuries, falls. They are workers’ compensation matters, and that pays the necessary treatment with no copay and no deductible.

The sequence: say “this happened at work” at registration, notify the employer in writing within 30 days, and file Form C-3 with the state board within two years. The form does not require a Social Security number, and every worker injured on the job in New York may file regardless of immigration status.

Where the “employer” is a household rather than an agency, the 40-hour threshold above decides whether coverage was required — which is exactly why the hour count is worth having in writing before anything happens. The full sequence.

One more thing, for the people you care for

The families you work with routinely do not know that Medicaid pays for non-emergency transportation to covered appointments at no cost, or that a pooled income trust lets someone over the income limit qualify for home care.

Neither is your responsibility. Both are worth knowing, because you will be asked. Medicaid transportation · Pooled income trusts.