Changes in how Medicaid managed care recipients obtain transportation to doctor or other medical providers in non-emergencies

Letter from Jason Helgerson to MLTC Plans responding to reports of fraudulent enrollment of people not medically eligible for MLTC from social adult day care centers.

HRA Alert announcing mandatory enrollment of LTHHCP consumers in managed care and managed long term care plans. The first letters are expected to be sent in early May. Eligible consumers have the option of enrolling in other waiver programs.

Data compiled by Evelyn Frank Legal Resources Program from MMCOR cost reports filed by plans with State Dept. of Health, released through Freedom of Information Request. Data for CY 2011

MLTC Plans (Partial Capitation) by Hours of Personal Care & Home Health Aide Services Provided – 2011 (In order of highest percentage of cases > 480 hours/month)(All solely NYC unless otherwise indicated). "Member months" means month in which plan reported providing a member with Personal Care or Home Health aide services. Since many members do not receive these services for an entire calendar year, this figure is more accurate than stating the total number of members who received the specified amount of hours.

Data compiled from MMCOR Reports filed by plans and disclosed to Evelyn Frank Legal Resources Program thru a FOIL request.. Full calendar year 2011.

Derived from Quarterly Managed Medicaid Cost and Operating Reports (MMCOR) data with the State Department of Health for 2011, obtained through FOIL request by NYLAG, analyzed by David Silva, EFLRP.

Chart showing all Medicare Advantage, Medicaid Advantage, Medicaid Advantage Plus and PACE plans in NYS - IN NEW YORK CITY by borough, with number of Medicare beneficiaries enrolled in each plan.

Medicare Advantage data from Feb. 2013 - http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/index.html

Medicaid plan data from Mar. 2013 - monthly Medicaid Managed Care Enrollment Report - http://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/

Chart showing all Medicare Advantage, Medicaid Advantage, Medicaid Advantage Plus and PACE plans in NYS - outside NYC by county, with number of Medicare beneficiaries enrolled in each plan.

Medicare Advantage data from Feb. 2013 - http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/index.html

Medicaid plan data from Mar. 2013 - monthly Medicaid Managed Care Enrollment Report

Critique of State Dept of Health Report on MLTC, prepared by Coalition to Protect the Rights of New York’s Dually Eligible, dated April 5, 2013

Form MM/MLTCXC-0612 Excludes from joining an MLTC Plan if:
* Are receiving family care home care by OMH agency
* Is receiving hospice care
* Has a developmental disability
* Resides in an ICF-DD, a residential Alcohol & Substance Abuse LTC Residential Program, in Foster Care Home, or
* has Complex mental health needs and receiving services through ICF or HCBS Waiver.