Managed long-term care (MLTC) is a system that streamlines the delivery of long-term services to people who are chronically ill or disabled and who wish to stay in their homes and communities. These services, such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health. The entire array of services to which an enrolled member is entitled can be received through the MLTC plan the member has chosen.
As New York transforms its long-term care system to one that ensures care management for all, enrollment in a MLTC plan may be mandatory or voluntary, depending on individual circumstances.
Enrollment in a MLTC plan is mandatory for those who:
- Are dual eligible (eligible for both Medicaid and Medicare) and over 21 years of age and need community based long-term care services for more than 120 days.
- Reside in the counties of NYC, Nassau, Suffolk or Westchester.
Enrollment in MLTC plan is voluntary for those who:
- Are dual eligible and are 18 through 21 years of age and need community based long term care services for more than 120 days and assessed as nursing home eligible.
- Are non-dual eligible and over 18 years of age and are assessed as nursing home eligible.
Am I eligible for managed long-term care?
You are eligible to enroll in managed long-term care if you:
- have a chronic illness or disability that makes you eligible for services usually provided in a nursing home;
- are able to stay safely at home at the time you join the plan;
- are expected to need long-term care services for at least 120 days from the date you enroll;
- meet the age requirement of the plan (the age requirement for a PACE organization is 55 years old; for most other plans, the age requirement is 65 years old);
- live in the area served by the plan;
- have or are willing to change to a doctor who is willing to work with the plan; and
- have a way of paying that is accepted by the plan. All plans accept Medicaid. Some plans also accept Medicare and Private Pay.
How do I enroll in managed long-term care?
To begin the process of enrolling in a PACE or MLTC plan, you, or someone on your behalf (family, friend, doctor), contacts the plan in your area. A staff person from the plan makes one or more visits to your home before you join to:
- explain to you the rules and responsibilities of plan membership;
- determine your eligibility for the plan;
- give you a copy of the member handbook and the plan’s provider network;
- assist you with completing the enrollment application and agreement;
- assist you with completing a Medicaid application, if needed;
- help you choose providers from the network of providers associated with the plan;
- set up a care plan with you by discussing your needs; and,
- answer any questions you may have.
How does MLTC affect my Medicaid and/or Medicare coverage?
If you are currently receiving Medicaid and/or Medicare services, you still receive the same types of services usually paid for by Medicaid and Medicare. You do not lose any of your regular Medicaid or Medicare benefits. If the Medicare or Medicaid service is not covered by the plan, you may still receive the service outside the plan using your Medicare or Medicaid card.
Must I enroll in MLTC if I live in NYC and need community-based long term care services such as personal care, home health services, therapies , private duty nursing and Adult Day Health Care?
On August 31, 2012, the Department received written approval from CMS to move forward with Medicaid Redesign Team Initiative #90 and to fully implement the transition and enrollment of recipients requiring community-based long term care into Managed Long Term Care Plans or Care Coordination Models beginning in New York City (NYC). This initiative amends the Partnership Plan Medicaid Section 1115 Demonstration waiver to require all dual-eligible individuals (persons in receipt of both Medicare and Medicaid) who are aged 21 or older and are in need of community-based long term care services for more than 120 days to be enrolled into Partial MLTCPs or CCMs. If you are a Medicaid recipient in NYC who meets the criteria above you must receive those services through a MLTC plan. Individuals who are presently receiving Medicaid community-based care services will be transitioned into MLTC over time. These individuals will receive information from Medicaid Choices, the Department’s Enrollment Broker about what consumers need to do and how to select a Plan. This mandatory enrollment for will continue throughout the State as Plan capacity is developed. The next set of counties include: Nassau, Suffolk, and Westchester scheduled at this time for January 2013 to begin the transition process.