Medicaid Managed Long Term Care
Managed Long Term Care Plans help provide services and support to people with a long-lasting health problem or disability. These plans are approved by the New York State Department of Health to provide Medicaid managed long term care. A plan can provide your Medicaid home care and other long term care benefits. To get these services, you may be required to join a Plan.
Who Must Join a Plan?
You must join a Plan if:
- You have both Medicaid and Medicare
- You need home care, adult day health care, or other long term care for more than 120 days (4 months)
- You are age 21 or older.
If You Currently Receive Home Care, Do You Have to Join a Plan?
If you receive homecare now, and have received a letter from New York Medicaid Choice telling you to join a Plan by a certain date, then you must join a plan by that date. If you do not choose a plan by the date specified on the letter, then the Medicaid Program will assign you to one of the MLTC Medicaid Plans in your borough or county.
What services will you get from a Plan?
All Plans provide Medicaid home care and other community long term care services. These are the services you are required to receive from a Plan.
Some plans also provide Medicare services, including doctor office visits, hospital care, pharmacy and other health-related services. If you join a Plan that covers Medicare health services, you must get your care from the Plan’s doctors and other providers.
Who Does Not Have to Join a Plan?
The following people are not required to join a Managed Long Term Care Plan. However they may join a Plan if they want :
- Native Americans
- Adults age 18-20 who need more than 120 days of community-based long term care
- Adults who are nursing home eligible and enrolled in the Medicaid Program for the working disabled
People Receiving the Following Services Cannot Join a Managed Long Term Care Plan. In Some Cases, You May Leave Your Program to Join a Plan:
- People enrolled in an Assisted Living Program
- People enrolled in the Traumatic Brain Injury (TBI), Nursing Home Transition & Diversion, or Long Term Home Health Care Program waivers
- People participating in the Consumer Directed Personal Assistance Program (CDPAP)
- People receiving hospice services or who are residents of a psychiatric or residential care facility or nursing home
- People who have a developmental disability and receiving care in a facility, in the community or through a waiver program, and those who have similar needs
- People are live in Family Care Homes licensed by the Office of Mental Health
- Residents of alcohol and drug abuse residential treatment programs
- People who have Medicaid eligibility only for tuberculosis-related services
- People who are uninsured and receiving breast and cervical cancer services and those who are under age 65 and eligible for the early detection program
- People who have Medicaid eligibility only for breast and cervical cancer services
- People who are eligible for the family planning expansion program
- People with less than 6 months of Medicaid eligibility or eligible for emergency Medicaid only
If you would like more help understanding your Managed Long Term Care options you can call 1-877-9-CARE-97 (1-877-922-7397) and one of our licensed Geriatric Care Managers will be happy to assist you.