New York Health Access - Managed Long Term Care

Managed Long Term Care

	Managed Long Term Care State Complaint Number for MLTC Problems - 1-866-712-7197 e-mail mltctac@health.ny.gov and put "COMPLAINT" in subject line For enrollment complaints - call NY Medicaid Choice - 1-855-886-0570 (Advocates line) 1-888-401-6582 (Consumers line) Managed Long Term Care (MLTC)...


	KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars A. Fact Sheets on Managed Long Term Care B. Click here for WEBINARS on LONG TERM CARE A. Fact Sheets on Managed Long Term Care BASICS Basics on Managed Long Term Care (In process of being updated - 2-2020) see also Article on Managed Long Term Care News on MLTC - updated monthly ...


	Getting Help with Managed Long Term Care and Other Types of Medicaid Managed Care Here are organizations where you can seek help for problems with Medicaid Managed Long Term Care (MLTC) plans, Medicaid Advantage Plus (MAP) plans, and Mainstream plans. Also see these KNOW YOUR RIGHTS Fact Sheets about MLTC and related topics STATEWIDE ICAN –...


	Tools for Choosing a Medicaid Managed Long Term Care Plan As described in this article, most adults in NYS who have Medicaid and Medicare, who need Medicaid personal care or CDPAP services or long-term CHHA or adult day care services, must select and enroll in a managed long term care plan, or a PACE or Medicaid Advantage Plus plan. Starting in May 2022...


	Requesting a New or Increased Service from a Medicaid Managed Care or MLTC Members of Medicaid Managed Care plans, including Managed Long Term Care (MLTC) plans, have the right to request a NEW service that was not previously authorized ("prior authorization"), or an INCREASE In a service they already have ("concurrent review"), such as more hours of personal care or...


	Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services NOTE: This article is about consumer rights when a Medicaid recipient "transitions" to or from a Managed Care plan. For information about care related to gender transitions, see Know Your Rights: What You Need to Know About Medicaid Coverage for Transition-Related Care. What is a Transition...


	Transition Rights after Enrolling in or Switching MLTC plans - 2022 Changes This article can also be downloaded as a Fact Sheet here. If you received Medicaid personal care or Consumer-Directed Personal Assistance (CDPAP) services, and then you were required to enroll in or transfer to a different Managed Long Term Care plan, your new Plan must continue to authorize...


	Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans - Changes start Nov. 1, 2024 Enrollment in a Medicaid Managed Long Term Care (MLTC) plan is mandatory for most adult Dual Eligibles (people who have Medicare or Medicaid), who need Medicaid personal care (PCS) or Consumer Directed Personal Assistance Program (CDPAP) services, with some exceptions - See also DOH list of...


	MLTC Members in Nursing Homes for 3+ Months Being Disenrolled from MLTC Plans - Since August 2020 In this article: Intro - What is the "Carve-out" of Nursing Home care from MLTC? Dashboard of Number of MLTC Members Disenrolled Procedures and Notices to Consumers for Disenrollment starting August 2020 Right to Re-enroll in the MLTC plan within SIX MONTHS after being...


	When an MLTC Plan Closes - What are the Members' Rights? WARNING - Changes Now in Effect Since Managed Long Term Care (MLTC) plan enrollment has been mandatory since 2013 for most adult "dual eligibles" (people with Medicaid and Medicare) who need Medicaid home care, some MLTC plans have either closed or reduced their service area, no longer covering certain counties or New York City....


	Appeals & Grievances in Managed Long Term Care & Managed Care In 2016, CMS adopted changes in federal Medicaid managed care regulations requiring "exhaustion" of Plan Appeals prior to requesting a Fair Hearing. These changes became effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F. Fact Sheet for Consumers Appeals in Managed...


	Medicaid Advantage Plus "MAP" - Integrated "FIDE" Appeals & Hearing Process Being Phased Out - Jan. 1, 2026 2025 UPDATE - The integrated" appeal and fair hearing process launched for in 2020 for members of Medicaid Advantage Plus (“MAP”) plans is being phased out to end Jan. 1, 2026. See the DOH MAP Integrated Hearings Phase-out plan here. Some integrated hearings will still be held after Jan....


	Some Medicaid Recipients are "Default Enrolled" into Medicare Special Needs Plans when they Enroll in Medicare Since April 1, 2021 Background Every month about 3,000 - 4,000 Medicaid recipients in New York State become enrolled in Medicare, either because they reach age 65 or after they collect Social Security Disability Insurance (SSDI) for 24 months. They become "Dual Eligibles" when they have both Medicare and Medicaid. ...


	Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay...


	Grievance and Appeal Contacts for Managed Long Term Care Plans SINCE MARCH 1, 2018, members of Medicaid Managed Care and Managed Long Term Care plans will be required to request an INTERNAL APPEAL within their plan, and wait until the plan decides that appeal before they may request a FAIR HEARING when they receive an Initial Adverse Determination denying or...


	Right to a "Home Hearing" under Varshavsky Case - Special Rights in Fair Hearings Seeking Increases in Medicaid Home Care RIGHTS of People Who Cannot Travel to a Fair Hearing Because of Disability This article can also be downloaded as a Fact Sheet here. Individuals who, because of mental or physical disabilities, cannot travel to a fair hearing without substantial hardship or medical detriment, have rights...


	Statistics on Medicare and Medicaid Managed Care -- Enrollment Numbers and other Data -- New York State Numbers tell a big part of the story of how managed care plans are doing in providing care. With mandatory enrollment in Medicaid managed care now required in every county in New York State for most people who do not have Medicare, and mandatory enrollment in Managed Long Term Care of those adults...


	Spousal Impoverishment Protections for Married Couples where One Spouse is in a Managed Long Term Care Plan - Pooled Trusts Allowed as an Option In this Article KNOW YOUR RIGHTS: Download Consumer Fact Sheet on Tips for Keeping More Income, including Spousal Impoverishment Protections.: What are Spousal Impoverishment Rules? Which Married couples can Use Spousal Impoverishment Protections? Spousal Impoverishment...