MLTC is mandatory for individuals:

• Who are dual eligible. (for both Medicaid and Medicare)
• Aged 21 years and up and need long-term care services for more than 120 days.
• Residing within the counties of NYC, Nassau, Suffolk, and Westchester.

MLTC is voluntary for individuals:

• Eligible for both Medicaid and Medicare.
• Aged 18 to 21 years old and need long-term care services for more than 120 days.
• Assessed as nursing home eligible.
• Who are non-dual eligible and are over the age of 18 and qualified for nursing home services.

You are qualified for MLTC if you:

• Have a chronic condition or disability qualified for nursing home services.
• Are able to stay safely at home at the time of enrollment.
• Meet the age requirement.
  • for a PACE organization, the age requirement is 55 years old.
  • for most other plans it is 65 years old.
• Live within the service areas.
• Are willing or have to change doctors who will manage your plan.
• Have a payment method accepted by the plan.
  • all plans accept Medicaid and some also accept Medicare and Private Pay.

How to Enroll in MLTC:

To begin the enrollment process in a PACE of MLTC plan, you or someone on your behalf will contact the plan provider in your area. A staff representative visits you in your home to asses your condition and needs before you join to:

• Explain the rules and responsibilities of the plan membership.
• Determine your eligibility for the service.
• Give you a copy of the member handbook and provider handbook.
• Assist you in completing the enrollment application and agreement.
• Assist in completing a Medicaid application, if needed.
• Help you choose a care provider suited to your requests.
• Discuss your care plan needs and requirements.

How Does MLTC Affect my Medicaid or Medicare Coverage?

If you are currently receiving Medicaid or Medicare services, you can still receive the same type of services usually paid for by these providers. You don’t lose any of your regular benefits. If the Medicare or Medicaid service is not covered in the plan, you may still receive the service out of the plan using your Medicare or Medicaid card.