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Medicaid Managed Care
NYLAG Comments on Proposed Changes in 1115 Waiver - ADL Limits for MLTC and Staying in Medicaid Managed Care when Enroll in Medicare Download
NYLAG CMS comments 1115 Waiver NYS 12-24-20.pdf
NYS DOH has requested that CMS change the 1115 waiver that governs MLTC and managed care in 2 ways. (1) Restrict enrollment in MLTC to those meeting new 2- or 3- ADL requirement enacted in State budget in April 2020; (2) Keep people in mainstream Medicaid managed care plans when they start getting Medicare, if they are enrolled in a Dual-Special Needs Plan. They could opt out but otherwise would automatically stay in managed care. See waiver request at https://content.govdelivery.com/accounts/USCMSMEDICAID/bulletins/2aea7cd. NYLAG comments posted here
24 Dec, 2020 1012 kb Downloads: 1274
NYLAG Comments on Medicaid State Plan Amendment to Implement the ADL Restrictions on Eligibility for Personal Care & CDPAP Download
Comments filed by NYLAG dated Oct. 29, 2020 on the proposed Medicaid State Plan Amendment (SPA) that would restrict elgibility for personal care and CDPAP services to require 2 or 3 ADL needs. The proposed SPA No. 20-41 was posted September 29, 2020 and is available at https://www.health.ny.gov/regulations/state_plans/status/ltcare/original/docs/os_2020-09-29_spa_20-41.pdf.
24 Dec, 2020 841 kb Downloads: 1206
Sample Notice to MLTC Members Explaining new Lock-In Rule that Starts Dec. 1, 2020 Download
Lock in notice 2020-10 redacted.pdf
Sample Notice sent to MLTC Members in October 2020 Explaining new Lock-In Rule that Starts Dec. 1, 2020. This notice is from VNS Choice, but each plan would be sending their own versiono n their letterhead, using State-approved language.
29 Oct, 2020 1.95 mb Downloads: 1873
MLTC Member Handbook Amendment - New "Lock-in" Download
MLTC Partial Lock In Member Handbook.pdf
Language that Plans must add to their MLTC Member Handbooks to explain the new Lock-in that begins Dec 1, 2020 for people enrolling in a plan after that date, whether a first-time enrollee or changing plans on or after that date
29 Oct, 2020 18 kb Downloads: 1836
NYLAG Comments on Proposed Changes to State Regulations for Medicaid Managed Care Appeals and Fair Hearings Download
Final Comments to Proposed Regulations Managed Care Fair Hearing 09.8.2020.pdf
NYLAG Comments filed on Sept. 8, 2020 on Proposed Changes to State Regulations for Medicaid Managed Care Appeals and Fair Hearings. The proposed amendments implement the "exhaustion" requirements implemented in NYS in 2018, implementing federal changes adopted in 2016.
23 Sep, 2020 511 kb Downloads: 1637
NYLAG COMMENTS on Proposed Home Care Changes - Eligibility and Assessment Procedures Download
NYLAG COMMENTS on Proposed Regulations implementing the Medicaid Home Care Changes - Eligibility and Assessment Procedures enacted in the 2020-21 NYS Budget. The proposed regulations are posted here - https://regs.health.ny.gov/sites/default/files/proposed-regulations/Personal%20Care%20Services%20and%20Consumer%20Directed%20Personal%20Assistance%20Program.pdf
09 Sep, 2020 1.07 mb Downloads: 1858
PowerPoint on NYS Medicaid Changes Coming in 2020-21 - Lookback, Restricted Home Care Eligibility & New Assessment Procedures Download
NYLAG Presentation - NYS Budget Changes - Medicaid FY 2020-21.pdf
Webinar presentation by Valerie Bogart, EFLRP, NYLAG, presented on Sept. 9, 2020 on upcoming changes in Medicaid - a new lookback for community based long term care services, new ADL requirements on eligibiliity for personal care and CDPAP, and new assessments for all home care in MLTC, managed care and local Medicaid offices
09 Sep, 2020 534 kb Downloads: 3613
Letters Asking Governor & State DOH to Halt Disenrollment from MLTC Plans for Nursing Home members until Pandemic Over Download
2020-07-02 Consumer LT GOV NH Disenrollment FINAL.pdf
Letter of 7/2/20 to Gov. Cuomo and letter dated June 29, 2020 to DOH from NYLAG, Legal Aid Society, CIDNY, Empire Justice Center & other organizations demanding the state halt disenrollment of almost 20,000 MLTC members from their MLTC plans because they have been in nursing homes for more than 3 months. With visitors banned from nursing homes, they'll have no help to appeal - and many will be forced to stay in the nursing homes, at risk of exposure to COVID.
12 Jul, 2020 1.37 mb Downloads: 1988
NYSDOH Dear Administrator Letter to Nursing Homes 6-11-2020 re Disenrollment from MLTC of Nursing Home Residents Download
DAL Updated NHBL 6.11.20.pdf
NYSDOH Dear Administrator Letter (DAL) to Nursing Homes 6/11/2020 revising the one issued 1-21-2020 (posted at http://www.wnylc.com/health/download/718). DAL advising them that residents who are members of MLTC plans will be disenrolled after 3 months in NY. The letter should eventually be posted with other DAL letters here - https://www.health.ny.gov/professionals/nursing_home_administrator/letters.htm#dal. See discussion in this article http://www.wnylc.com/health/entry/199/
28 Jun, 2020 181 kb Downloads: 2100
NYLAG, Empire Justice Center & Bronx Legal Serv Letter to DOH re MLTC/ Home Care Protections re Covid-19 0 4/1/2020 Download
Letter from Advocates to NYS Dept. of Health requesting clarification of various policies issued re Covid-19 and for protections for Medicaid home care applicants and recipients in MLTC, mainstream managed care plans and other home care programs.
03 Apr, 2020 432 kb Downloads: 2413
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