Attachment 3: Draft NYSDOH Nursing Home Lock-In Member Notice

  • Letter is also available in Portable Document Format

Dear [Insert Member Name],

This letter is to inform you of a change in State law that may impact your enrollment in New York State Medicaid Partial Capitation Managed Long–Term Care (MLTC) plan.

Beginning [December 1, 2018 (requested; subject to CMS approval)] new enrollment into an MLTC plan will be subject to a lock–in period. If you switch from your MLTC plan to another MLTC plan on or after December 1, you will have a 90–day grace period to make another plan transfer, and then will experience a lock–in period for nine months after the end of your grace period (for a total period of one year from the date of enrollment).

During the lock–in period, you may transfer to another MLTC plan if you show good cause. Examples of good cause include, but are not limited to: moving out of your MLTC plan’s service area, failure of your MLTC plan to furnish services to you, to continue being cared for by your home care worker, or if your enrollment was non–consensual.

After the lock–in period, you may transfer to another MLTC plan for any reason. Enrolling in a new MLTC plan will start a new lock–in period.

This change only applies if you are transferring from one MLTC partially capitated plan to another MLTC partially capitated plan. It does not apply if you decide to enroll into any of the following integrated plans: Fully Integrated Duals Advantage (FIDA), Medicaid Advantage Plus (MAP), and the Program of All–Inclusive Care for the Elderly (PACE). Information about these plans is available by contacting New York Medicaid Choice at 1–800–401–6582.

What If I Have Questions About This Change?

The following supports are available to assist in answering your questions:

  1. [Insert Plan Name] is glad to answer your questions and can be reached by calling your Member Services at [Insert Plan Member Service Phone Number], [Insert Plan Member Service Hours of Operation]. [Insert TTY/TDD Information].
  2. Contact New York Medicaid Choice at 1–800–401–6582. The New York Medicaid Choice counselors can help explain if lock–in applies to you and when it does apply if you might have a good cause reason to change.
  3. The Independent Consumer Advocacy Network (ICAN) is a free service sponsored by NYS Department of Health. ICAN can connect you with a counselor who can provide free, confidential and independent assistance regarding your long–term care services. You can contact ICAN at (844) 614–8800 between the hours 8 AM to 8 PM (TTY users should call 711, then follow the prompts to dial 844–614–8800).


New York State Department of Health