Guide on MLTC in New York

Understanding Managed Long Term Care (MLTC)

Managed Long-Term Care (MLTC) is a system designed to provide comprehensive health and long-term care services to individuals who are chronically ill or disabled and prefer to remain in their homes and communities. MLTC plans, approved by the New York State Department of Health, arrange and cover a wide range of entitled services selected by the member, offering choice and flexibility in accessing necessary services from a single source (source).

What is Managed Long Term Care?

Managed Long Term Care (MLTC) helps individuals who are chronically ill or have disabilities by providing health and long-term care services, such as home care or adult day care, enabling them to stay in their homes and communities for as long as possible. These services are arranged and paid for by the MLTC plan, offering choice and flexibility in obtaining necessary services from a single source (NY Department of Health).

Benefits of Managed Long Term Care

Managed Long Term Care (MLTC) plans in New York offer various benefits to individuals with chronic illnesses or disabilities. Some of the key advantages include:

1. Comprehensive Care: MLTC plans cover a wide range of health and long-term care services, including home care, adult day care, and other entitled services. This comprehensive approach ensures that members receive the necessary care and support to meet their specific needs.
2. Choice and Flexibility: MLTC plans provide members with the freedom to choose their preferred providers and services from a network of approved providers. This allows individuals to personalize their care and select providers who best align with their needs and preferences.
3. Care Coordination: MLTC plans offer care coordination services to help members navigate the complex healthcare system. Care coordinators work closely with individuals, their families, and healthcare providers to develop and implement personalized care plans, ensuring that all necessary services are effectively coordinated.
4. Cost Savings: MLTC can potentially result in cost savings for individuals who require long-term care services. By providing an array of services through a single plan, MLTC can streamline the delivery of care, reducing administrative burdens and costs associated with multiple providers and services.
5. Community-Based Care: MLTC emphasizes the importance of community-based care, allowing individuals to receive the care they need in the comfort of their own homes and communities. This approach promotes independence and enhances the overall quality of life for members.

Managed Long Term Care (MLTC) plays a vital role in supporting individuals with chronic illnesses or disabilities, ensuring that they receive the necessary care and services to maintain their well-being and independence. By understanding the concept of MLTC and the benefits it offers, individuals can make informed decisions about their long-term care options in New York.

Enrollment in Managed Long Term Care

When it comes to enrolling in Managed Long Term Care (MLTC) in New York, there are important considerations regarding mandatory and voluntary enrollment options. Understanding the enrollment process is crucial for individuals seeking long-term care services.

Mandatory vs. Voluntary Enrollment

Enrollment in MLTC plans can be either mandatory or voluntary, depending on individual circumstances and the location within New York. As the state undergoes a transformation of its long-term care system to ensure care management for all, the enrollment requirements have evolved.

In New York City (NYC), for individuals aged 21 or older who require community-based long-term care services for more than 120 days, enrollment in MLTC plans became mandatory as per the Medicaid Redesign Team Initiative #90, approved by the Centers for Medicare and Medicaid Services (CMS) in August 2012 (source). This initiative is part of the Partnership Plan Medicaid Section 1115 Demonstration waiver.

Outside of NYC, enrollment in MLTC plans may be mandatory or voluntary depending on individual circumstances. The transition to mandatory enrollment in MLTC plans for dually eligible individuals aged 21 and older receiving or applying for community-based long-term care services was approved by CMS in September 2012 through a federal government Medicaid agency "CMS" for an "1115 waiver" (WNYLC). This shift aims to ensure comprehensive care management for eligible individuals.

How to Enroll in Managed Long Term Care

Enrolling in MLTC involves a step-by-step process to ensure individuals receive the necessary long-term care services. The specific steps may vary based on the circumstances and location within New York. Here is a general overview of the enrollment process:

1. Assessment: The initial step involves an assessment by a care manager to determine eligibility for MLTC services. The care manager evaluates the individual's needs, current living situation, and medical history.
2. Plan Selection: Upon eligibility determination, individuals have the option to select a managed long-term care plan. It is important to review and compare the available plans to find the one that best aligns with specific needs.
3. Application: After selecting a plan, individuals need to complete the MLTC application provided by the chosen plan. The application includes personal and medical information required for enrollment.
4. Submission: Once the application is complete, it should be submitted to the MLTC plan either online, by mail, or in person, following the instructions provided by the plan.
5. Enrollment Confirmation: After reviewing the application, the MLTC plan will send an enrollment confirmation letter. This letter serves as proof of enrollment and provides details about the effective date of coverage and the assigned care manager.

It is crucial to follow the specific instructions provided by the chosen MLTC plan and consult with a healthcare professional or the New York State Department of Health for any additional guidance.

Understanding the nuances of mandatory and voluntary enrollment and following the correct steps for enrollment will ensure access to the necessary long-term care services through MLTC plans in New York.

Services Covered by Managed Long Term Care

Managed Long Term Care (MLTC) programs in New York aim to support individuals with chronic illnesses or disabilities by providing a range of health and long-term care services. These services are designed to help individuals remain in their homes and communities for as long as possible, promoting independence and a higher quality of life. The services covered by MLTC plans include home care services, adult day care services, and other essential services.

Home Care Services

Home care services are a key component of MLTC plans. These services are provided to individuals in their own homes, offering assistance with activities of daily living and medical care. Home care services typically include:

• Personal care assistance, such as help with bathing, dressing, and grooming.
• Medication management and administration.
• Skilled nursing care for individuals requiring medical attention.
• Physical, occupational, and speech therapy.
• Home health aide services to assist with daily tasks.

The specific services provided may vary based on the individual's needs and the MLTC plan. MLTC plans work with a network of licensed home care agencies to ensure the provision of high-quality care.

Adult Day Care Services

Adult day care services are another important component of MLTC plans. These services are designed to provide a safe and supportive environment for individuals who require supervision and socialization during the day. Adult day care services may include:

• Social activities, recreational programs, and mental stimulation.
• Assistance with personal care and medication management.
• Nutritious meals and snacks.
• Health monitoring and oversight.
• Transportation to and from the adult day care center.

Adult day care services not only offer individuals a chance to engage in meaningful activities but also provide respite for caregivers who may need a break from their caregiving responsibilities.

Other Covered Services

In addition to home care and adult day care services, MLTC plans may cover a range of other services to meet the unique needs of individuals enrolled in the program. These services may include:

• Care management services to coordinate and oversee the individual's care.
• Medical equipment and supplies necessary for the individual's health and well-being.
• Physical therapy, occupational therapy, and speech therapy.
• Nutritional counseling and support.
• Transportation services for medical appointments and other essential activities.

The specific services covered may vary depending on the MLTC plan and the individual's needs. MLTC plans work closely with healthcare providers and community organizations to ensure comprehensive care and support.

Understanding the services covered by MLTC plans is crucial for individuals considering enrollment. By providing a range of essential services, MLTC plans aim to enhance the overall well-being and independence of individuals with chronic illnesses or disabilities, allowing them to receive the care they need while remaining in their homes and communities.

Managed Long Term Care Plans in New York

In New York State, Managed Long Term Care (MLTC) is a system designed to provide long-term services to individuals with chronic illnesses or disabilities who prefer to receive care in their homes and communities. Two primary models of MLTC exist: Programs of All-Inclusive Care for the Elderly (PACE) and Managed Long-Term Care Plans.

Programs of All-Inclusive Care for the Elderly (PACE)

PACE Organizations offer comprehensive healthcare services to members aged 55 and older who are eligible for nursing home admission. These organizations provide a wide range of services funded by both Medicare and Medicaid. PACE aims to support individuals in maintaining their independence and quality of life while receiving the necessary care.

Managed Long-Term Care Plans

Managed Long-Term Care Plans are another model of MLTC in New York. These plans focus on providing long-term care services to individuals with chronic conditions or disabilities. Most members of these plans are at least 65 years old and receive Medicaid payment for their care. Managed Long-Term Care Plans are approved by the New York State Department of Health and offer a variety of entitled services selected by the member.

To ensure individuals have access to necessary long-term care services, New York transitioned from voluntary enrollment to mandatory enrollment in MLTC plans on September 4, 2012. This transition was made possible through the approval of a federal government Medicaid agency "CMS" for an "1115 waiver." As a result, all dually eligible individuals aged 21 and older who are receiving or applying for community-based long-term care services are required to enroll in an MLTC plan.

It's important to note that the transition to Managed Long-Term Care Plans may vary across different regions. In New York City (NYC), for example, it is mandatory for individuals requiring community-based long-term care services to enroll in a Managed Long-Term Care Plan based on the Medicaid Redesign Team Initiative #90. This initiative, approved by CMS in 2012, requires dual-eligible individuals aged 21 or older in need of such services for over 120 days to be enrolled in Partial MLTCPs or Care Coordination Models in NYC. The transition process will extend throughout the state as plan capacity is developed.

By enrolling in a Managed Long Term Care Plan in New York, individuals with chronic illnesses or disabilities can access the necessary long-term care services while receiving the support they need to remain in their homes and communities.

Transitioning to Managed Long Term Care

When transitioning to Managed Long Term Care (MLTC), it's essential to understand your rights and the changes that may occur in service hours and regulations. This section will cover the transition rights and continuation of services, as well as the changes that may arise during the process.

Transition Rights and Continuation of Services

As of November 8, 2021, changes in transition rights have been implemented to ensure the continuation of past services for individuals required to enroll in MLTC plans. This means that if you are transitioning to an MLTC plan, you have the right to continue receiving the same services you were receiving before for a period of 90 or 120 days, depending on your situation (WNYLC).

These transition rights are particularly important in cases of involuntary disenrollment, where individuals are removed from their previous care arrangement. In such situations, the transition rights help guarantee the continuation of services during the transition period.

Changes in Service Hours and Regulations

Under new regulations effective November 8, 2021, MLTC plans have the ability to reduce service hours without requiring proof of a change in medical condition. However, this reduction in hours is only permitted in specific circumstances for members transitioning to an MLTC plan from receiving Medicaid home care services from other sources, such as the local Department of Social Services (DSS), a mainstream plan, or a closed MLTC plan (WNYLC).

It's crucial to be aware of these changes and understand that reductions in service hours may occur during the transition process. If you have any concerns or questions about the changes in service hours, it's recommended to reach out to your MLTC plan for clarification.

Additionally, it's worth noting that special spousal impoverishment protections apply in MLTC under New York regulations since September 2013. These protections are in place to safeguard the spouses of individuals enrolled in MLTC plans (WNYLC).

As you transition to MLTC, it's important to stay informed about your rights and any changes that may occur. Familiarize yourself with the details of your MLTC plan and communicate with the plan representatives to ensure a smooth transition and continuity of care.

By understanding the transition rights and being aware of changes in service hours and regulations, you can navigate the process of transitioning to MLTC with confidence and ensure that you receive the appropriate care and support for your long-term needs.

Language Accessibility in Managed Long Term Care

Language should never be a barrier to receiving managed long-term care services, and in New York, efforts have been made to ensure that language accessibility is prioritized. Most managed long-term care plans have taken steps to address this issue by providing bilingual staff, materials in multiple languages, and offering oral translation services free of charge.

Bilingual Staff and Translation Services

To ensure effective communication with individuals who do not speak English as their primary language, most managed long-term care plans have bilingual staff members. These staff members are trained to provide assistance and guidance in multiple languages, facilitating clear and comprehensive communication between the plan and the enrollees (NY State Department of Health).

In addition to bilingual staff, written materials, such as brochures, enrollment forms, and informational guides, are often available in various languages. This allows individuals with limited English proficiency to have access to important information about the managed long-term care services available to them.

Moreover, oral translation services are offered by each managed long-term care plan at no cost. These services ensure that individuals who require language assistance can communicate effectively with healthcare providers, care managers, and other relevant personnel. Whether through telephone interpretation or face-to-face meetings, these translation services aim to bridge the language gap and ensure that enrollees fully understand their options and receive the care they need.

Access to Providers of Different Languages

In addition to providing bilingual staff and translation services, managed long-term care plans also provide information about providers who speak languages other than English. This ensures that individuals can find healthcare providers who can communicate with them in their preferred language.

By offering access to providers who speak different languages, managed long-term care plans strive to create a supportive and inclusive environment for all enrollees. This enables individuals to communicate their needs and concerns effectively, fostering a better understanding of their healthcare options and enhancing the overall quality of care they receive.

In summary, language accessibility is a priority in managed long-term care in New York. Most plans have taken steps to overcome language barriers by employing bilingual staff, providing written materials in various languages, and offering oral translation services free of charge. Additionally, access to healthcare providers who speak languages other than English ensures that individuals can communicate their needs and receive appropriate care. These efforts aim to ensure that language is never a hindrance to receiving the necessary managed long-term care services.

Recent Updates in Managed Long Term Care

As the landscape of Managed Long Term Care (MLTC) continues to evolve, it's essential to stay informed about the recent updates and changes in the field. In this section, we will explore two significant updates related to MLTC in New York: the resumption of involuntary disenrollments and the expansion of dental coverage with simplified access.

Involuntary Disenrollments Resumed

The New York State Department of Health has announced the resumption of involuntary disenrollments for Managed Long Term Care (MLTC) plans as the department transitions back to regular rules post the COVID-19 Public Health Emergency. This guidance applies to Partial Capitation, Medicaid Advantage Plus (MAP), and Programs of All-Inclusive Care for the Elderly (PACE) plans. The resumption of involuntary disenrollments means that individuals who no longer meet the eligibility criteria or fail to comply with the plan requirements may be involuntarily disenrolled from their MLTC plan. It is important for MLTC plan participants to review and adhere to the plan's guidelines to maintain their enrollment and access to long-term care services. More information on the resumption of involuntary disenrollments can be found on the New York State Department of Health website.

Dental Coverage and Simplified Access

Effective January 31, 2024, there have been notable changes in dental coverage under Managed Long Term Care (MLTC) in New York. Medicaid will now cover crowns and root canals under specific circumstances, allowing for the preservation of natural teeth. Moreover, receiving replacement dentures and implants will only require a recommendation from a dentist, simplifying access to these dental services. This expansion of dental coverage aims to improve the oral health and overall well-being of individuals enrolled in MLTC plans. By providing coverage for necessary dental procedures, individuals can maintain their oral health, enhancing their quality of life. For more details on the coverage and accessibility of dental services under MLTC, you can refer to the information provided by the New York State Department of Health.

Keeping abreast of recent updates in Managed Long Term Care is essential for individuals enrolled in MLTC plans. By staying informed about changes in involuntary disenrollments and the expansion of dental coverage, individuals can ensure they receive the necessary care and make informed decisions regarding their long-term care needs. It is recommended to consult the New York State Department of Health for the most up-to-date information and resources related to MLTC in New York.

Resources for Managed Long Term Care

When it comes to Managed Long Term Care (MLTC), it's important to have access to reliable resources and information. Here are two key resources that can assist individuals in navigating the MLTC system in New York.

New York State Department of Health

The New York State Department of Health (NYSDOH) plays a vital role in overseeing and regulating the MLTC program. They provide a comprehensive directory of MLTC plans approved to operate by county, allowing individuals to search for information about specific MLTC plans in their area (New York State Department of Health). This directory serves as a valuable resource for individuals seeking to enroll in an MLTC plan or gather information about the available options.

The NYSDOH website also offers a wealth of information regarding MLTC, including eligibility requirements, program updates, and frequently asked questions. Individuals can access relevant forms, documents, and guidelines to assist them in understanding and navigating the MLTC system. The NYSDOH is committed to providing accurate and up-to-date information to help individuals make informed decisions about their long-term care needs.

Local Managed Long Term Care Plans

In addition to the NYSDOH, local MLTC plans are an important resource for individuals seeking managed long-term care services. These plans are approved by the New York State Department of Health to provide a range of services, such as home care and adult day care, to eligible individuals (Source). Each MLTC plan may have its own network of providers, coverage options, and enrollment process.

To access information about local MLTC plans, individuals can refer to the NYSDOH directory mentioned earlier. This directory provides contact information and details about the MLTC plans operating in each county. It is advisable to reach out to the specific MLTC plan of interest to obtain detailed information about their services, enrollment process, and any additional resources they may offer.

By utilizing these resources, individuals can gather the necessary information and guidance to make informed decisions about managed long-term care. Whether accessing the NYSDOH website or reaching out to local MLTC plans, these resources aim to assist individuals in navigating the MLTC system effectively and accessing the care they need.

Sources

New York State Department of Health

WNYLC