About Managed Long Term Care
Managed long-term care might be the right option for you or a loved one. Read below for answers to frequently asked questions about the managed long-term care program.
- What is managed long-term care (MLTC)?
- Are there different types of managed long-term care?
- Am I eligible for managed long-term care?
- How do I enroll in managed long-term care?
- How does MLTC affect my Medicaid and/or Medicare Coverage?
- 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?
- My mother isn't fluent in English. Will this be a problem?
What is managed long-term care (MLTC)?
Managed long-term care (MLTC) helps people who are chronically ill or have disabilities and who need health and long-term care services, such as home care or adult day care, stay in their homes and communities as long as possible. The MLTC plan arranges and pays for a large selection of health and social services, and provides choice and flexibility in obtaining needed services from one place.
Are there different types of managed long-term care?
There are two basic models of managed long-term care in New York State: Programs of All-Inclusive Care for the Elderly (PACE) and Managed Long-Term Care Plans.
A PACE organization provides a comprehensive system of health care services for members age 55 and older who are otherwise eligible for nursing home admission. Both Medicare and Medicaid pay for PACE services (on a capitated basis). PACE members are required to use PACE physicians and an interdisciplinary team develops care plans and provides on-going care management. The PACE is responsible for directly providing or arranging all primary, inpatient hospital and long-term care services required by a PACE member. The PACE is approved by the U.S. Centers for Medicare and Medicaid Services.
Managed Long-Term Care Plans
Managed long-term care plans provide long-term care services (like home health and nursing home care) and ancillary and ambulatory services (including dentistry, and medical equipment), and receive Medicaid payment. Members get services from their primary care physicians and inpatient hospital services using their Medicaid and/or Medicare cards. Members must be eligible for nursing home admission. While several plans in New York State enroll younger members, most managed long-term care plan enrollees must be at least age 65.
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.
See the Managed Long-Term Care Plan Directory to find out which plans accept Medicaid, Medicare or private pay enrollees.
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.
My mother is not fluent in English. Will this be a problem?
No. Language is not a barrier to receiving managed long-term care services. Most plans have bi-lingual staff and written materials are prepared in several languages. Oral translation services are available from each managed long-term care plan free of charge. Each plan has the names, locations and telephone numbers of providers who speak languages other than English. Contact the plan in your area to get this information.