MRT 11204: MLTC Lock-in Proposal/Restriction of Members Transferring to Plans for a Period of 12 Months

This law establishes a mandate that individuals who enroll in a partially capitated MLTC plan will be prohibited from transferring to another available MLTC plan more than once a year, unless good cause is demonstrated. Each member will be allowed a grace period of 90 days from point of enrollment, during which time they may elect one transfer for any reason. For the remainder of a twelve-month period beginning with the effective date of their enrollment, enrollees may pursue transfer if good cause is demonstrated.

New York has submitted a request to amend its Medicaid Redesign Team (MRT) demonstration, with the goal of the amendment being to limit the nursing home benefit in Managed Long Term Care Capitation Plans (MLTCP) to three months for enrollees who have been designated as permanently placed in a skilled nursing or residential health care facility (nursing home). After the three-month period, the beneficiary will be involuntarily disenrolled and coverage for nursing home services, in the same facility, will be covered by Medicaid fee-for-service-as long as the individual qualifies for institutional Medicaid coverage. The amendment also aligns the lock-in policy of MLTCP with Mainstream Managed Care Plans (MMCP). The federal public comment period will be open from September 26, 2018 through October 26, 2018.

To provide stakeholders additional time to comment on the proposed amendment, the Department is accepting comments for an additional thirty days or until November 23, 2018. Comments can be submitted via email to In the subject line please indicate Proposed NH Benefit/Lock In 1115 Amendment Comments.