Managed Long Term Care (MLTC)

What's New

Announcement: DOH/NYSOFA Release SADC/SADS HCBS Final Rule Compliant PCSP Template (Full Announcement) (PDF)

DOH has collaborated with the NYS Office for the Aging (NYSOFA) to develop a Home and Community Based Services (HCBS) Final Rule compliant Social Adult Day Care (SADC) and Social Adult Day Services (SADS) Person Centered Service Plan (PCSP) template. This template is a care planning document that is utilized to ensure the person-centered planning (PCP) process is performed appropriately per HCBS Final Rule requirements.

The template has been posted to the DOH and NYSOFA websites and is available here: SADC/SADS Person Centered Service Plan Template (Word)

DOH and NYSOFA require all SADC/SADS sites to utilize the issued PCSP template or update their PCSP template to include at minimum all questions and areas covered in the DOH/NYSOFA issued template. MLTC plans are required to verify that their contracted SADC/SADS sites comply with the new PCSP template requirements, and when contracting with a new SADC/SADS site, MLTC plans must verify the DOH/NYSOFA template or corresponding template is already in use or will be once members begin attending.

Upcoming Changes to New York State Medicaid Dental Services

Beginning January 31, 2024, Medicaid will be covering crowns and root canals in certain circumstances so that you can keep more natural teeth.

In addition, replacement dentures and implants will only need a recommendation from your dentist to determine if they are necessary. This will make it easier for you to access these dental services.

We have informed participating dentists of these changes.

If you have questions about this information, we are here to assist you.

  • If you have a Medicaid Managed Long Term Care Dental Plan, please call the number on the back of your identification card or email mltcinfo@health.ny.gov.
  • If you have Fee-for-Service Medicaid, please call (518) 473-2160 or email dentalpolicy@health.ny.gov.

Providers can find more information here: Update: NYS Medicaid Program Dental and Procedure Code Manual.


MLTC Unwinding from the COVID-19 Public Health Emergency

Resumption of MLTC Involuntary Disenrollments

This guidance applies to Partial Capitation, Medicaid Advantage Plus (MAP), and Programs of All Inclusive Care for the Elderly (PACE) plans.

As the Department returns to regular rules post the Public Health Emergency, this is to announce the release of MLTC Policy 23.03, the Resumption of MLTC Involuntary Disenrollments. Please see the guidance attached and posted here MLTC Policy 23.03: Resumption of MLTC Involuntary Disenrollment Guidance (ny.gov). Packets with required MLTC supporting documentation can be submitted to NYMC for December 1, 2023 involuntary disenrollment effective dates and thereafter.

Please read the instructions contained in MLTC Policy 23.03 Resumption of MLTC Involuntary Disenrollments to ensure your MLTC plan’s understanding and compliance to the MLTC contractual requirements for these resumed involuntary disenrollments. This guidance supersedes the five previous MLTC involuntary disenrollment reasons resumed during the Public Health Emergency.

Please send questions to mltcinfo@health.ny.gov with the subject line: Resumption of MLTC Involuntary Disenrollments. An FAQ document will be forthcoming hereafter.

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.

MLTC Overview

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 following counties:
    1. Effective 2012-2013 - NYC, Albany, Erie, Monroe, Nassau, Onondaga, Orange, Rockland, Suffolk & Westchester
    2. Effective 2014 - Broome, Cayuga, Chenango, Columbia, Cortland, Delaware, Dutchess, Fulton, Genesee, Greene, Herkimer, Livingston, Madison, Montgomery Niagara, Oneida, Ontario, Orleans, Oswego, Otsego, Putnam, Rensselaer, Saratoga, Schenectady Schoharie, Steuben, Sullivan, Tioga, Tompkins, Ulster, Washington, Warren, Wayne, Wyoming
    3. Effective 2015 - Allegany, Cattaraugus, Chautauqua, Chemung, Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, St. Lawrence, Seneca, Schuyler, Yates

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.

To learn more about the migration of long-term care services to a managed care environment, click here for the MRT 90 webpage:

To learn more about the managed long-term care options available, choosing a plan, covered services and enrollee rights, click here:

To see a list of available MLTC plans, click here:

To learn how the different MLTC plans rate, click here:


NYS MLTC Plan Information

Service Authorization, Appeals, and Notices

Health Plan Specific Member Handbook

NYS Model Member Handbooks

  • Partial Capitation - (Web) - (PDF)
  • Medicaid Advantage (Note: This program ended December 31, 2021.)
  • Medicaid Advantage Plus - (Web) - (PDF)

NYS Contracted Health Plan Provider Directories

NYS Contracted Health Plan Ownership and Control Interest Information

NYS Contracted Health Plan Network Adequacy Standards