July 12, 2012
The purpose of this ALERT is to inform Community Based Organizations, Client Representatives, Certified Home Health Agencies and other providers that the Medical Assistance Program is changing the way it processes Medicaid applications for excess income eligible consumers seeking enrollment into a Managed Long Term Care (MLTC) plan. Consumers seeking MLTC enrollment who are found to only be eligible for the Medicaid Excess Income (Surplus) Program will now have their cases accepted and authorized with “06” (provisional) coverage. This will occur even if their applications are received without bills that cover their excess or surplus.

This new process will allow MLTCplans to see the provisional coverage on ePaces/eMedNY and will facilitate receipt of services for these consumers. Submitters are requested, when appropriate, to prominently indicate on the cover sheet of submitted applications that the consumer intends to enroll into an MLTC plan

Current policy will remain unchanged for all other consumers found eligible for the Excess Income Program.

Letter expresses concern about potential for member disruption due to PPL's operational issues, data and system shortcomings, and financial capacity to pay workers.

NYLAG's Memo in support of bill in FY 2025- 2026calling for the State to increase transparency about MLTC - where does the money go, what services are provided and how much, track record of plans in keeping members out of nursing homes, etc.

List adapted from NYS DOH List posted at https://www.health.ny.gov/health_care/medicaid/redesign/duals/index.htm (scroll down to IB-DUAL drop down and then to end). This list adds the names of the Medicare D-SNP plans and also names of counties that are excluded from Default Enrollment. Separate Excel file is posted. Some info taken from CMS 2025 plan files at http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn (NYS extracted at http://health.wnylc.com/health/download/864/). Last page lists MAP plans that do NOT have Default Enrollment, with counties and aligned D-SNP plans.

List adapted from NYS DOH List posted at https://www.health.ny.gov/health_care/medicaid/redesign/duals/index.htm (scroll down to IB-DUAL drop down and then to end). This list adds the names of the Medicare D-SNP plans and also names of counties that are excluded from Default Enrollment. Separate PDF file is posted. Some info taken from CMS 2025 plan files at http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn (NYS extracted at http://health.wnylc.com/health/download/864/). Second tab shows MAP plans with NO Default Enrollment.

2025 NYS Medicare Advantage and Special Needs Plans - see different tabs for different types of plans and NYC Medicare Advantage plan list. Can filter list by county, company, etc. Revised to include Star Ratings and Default Enrollment info

NYLAG's statement opposing various cuts to the Consumer-Directed Personal Assistance Program proposed by the Governor in the 2024-25 Budget. (revised 2/27/24)

NYLAG Memo in Support of HOME CARE SAVINGS AND REINVESTMENT ACT (S7800/A8470) that would replace the MLTC program with a managed fee- for service program.

2024 Medicare Special Needs Plans (SNPs) in NYS, with Star Ratings (as of 10/5/23). Indicates whether plan is aligned with and part of a Medicaid Advantage Plus (MAP) plan (includes MLTC plan in same plan) or an IB-Dual plan (Integrated benefit - Dual) which is a type of a Medicaid managed care plan for people who have Medicare. These plans are subject to Default Enrollment. See http://health.wnylc.com/health/entry/226/ and https://www.health.ny.gov/health_care/medicaid/redesign/duals/index.htm

NYLAG filed these comments on June 30, 2023 to the federal CMS Medicaid agency's proposal to improve standards for accessing Home and Community-Based Services (HCBS) Provisions - see CMS summary at https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-cms-2442-p-notice-proposed-rulemaking and

https://www.cms.gov/newsroom/press-releases/biden-harris-administration-proposes-new-standards-help-ensure-access-quality-health-care-medicaid#