Mandatory Managed Long Term Care Enrollment Plan

February 16, 2012


Enrollment Plan Mandatory Managed Long Term Care and Care Coordination Model

  • Mandatory Population: Dual eligible, aged 21 and over, receiving community based long term care services for over 120 days, excluding the following for now:
    • Nursing Home Transition and Diversion waiver participants;
    • Traumatic Brain Injury waiver participants;
    • Nursing home residents;
    • Assisted Living Program participants;
    • Dual eligible that do not require community based long term care services.

Voluntary Population

  • In addition to those who must enroll in a Managed Long Term Care Plan or Care Coordination Model, the following people may voluntarily enroll:
    • Dual eligible, 18-21, in need of community based long term care services for over 120 days.
    • Dual eligible age 18-21 and non-dual eligible age 18 and older assessed as nursing home eligible.

Phase I: New York City

People New to Service

  • Beginning July 1, 2012 - Any dual eligible case new to service, fitting the mandatory definition in any New York City county will be identified for enrollment and referred to the Enrollment Broker for action.
    • Enrollment Broker will provide with educational material, list of plans/CCMs, answer questions and provide assistance contacting a plan if requested.
    • Plan/CCM will conduct assessment to determine if eligible for community based long term care.
    • Plan/CCM transmits enrollment to Enrollment Broke

People in Service

  • Enrollment will be phased-in by service type by borough by zip code in batches. People will be given 60 days to choose a plan according to the following schedule:
    • July 1, 2012: Begin personal care cases in New York County.
    • August 1, 2012: Continue personal care cases in New York County.
    • September, 2012: Continue personal care cases in New York County and begin personal care in Bronx County; and begin consumer directed personal assistance program cases in New York and Bronx counties.
    • October, 2012: Continue personal care and consumer directed personal assistance program cases in New York and Bronx counties and begin Kings County.
    • November 2012: Continue personal care and consumer directed personal assistance program cases in New York, Bronx and Kings counties
    • December 2012: Continue personal care and consumer directed personal assistance program cases in New York, Bronx and Kings Counties and begin Queens and Richmond counties
    • January 2013: Initiate enrollments citywide of long term home health care program, home health over 120 days, adult day health care program and private duty nursing cases not enrolled under personal care case activity.
    • February 2013 and until all people in service are enrolled: Personal care, consumer directed personal assistance program, long term home health care program, home health over 120 days, adult day health care program and private duty nursing cases in New York, Bronx, Kings, Queens and Richmond Counties
      • Individuals receiving personal care while enrolled in Medicaid Advantage will begin MLTC/CCM enrollment in January, 2013.

Next Phase(s)

  • As plan capacity is established, dually eligible community based long term care service recipients will be enrolled as follows::
    • Phase II: Nassau, Suffolk and Westchester Counties - Anticipated January 2013.
    • Phase III: Rockland and Orange Counties - Anticipated June 2013.
    • Phase IV: Albany, Erie, Onondaga and Monroe Counties - Anticipated December 2013.
    • Phase V: Other counties with capacity - Anticipated June 2014.

Final Phase

Phase Vi: Previously excluded dual eligible groups contingent upon development of appropriate programs:

  • Nursing Home Transition and Diversion waiver participants;
  • Traumatic Brain Injury waiver participants;
  • Nursing home residents;
  • Assisted Living Program participants;
  • Dual eligibles that do not require community based long term care services.