This list was released by DOH to the Long Term Care Community Coalition in April 2013, in response to a Freedom of Information request

FAQ clarifying issues that pose barriers to enrollment into MLTC plans. Many of these problems stem from "coding" problems - eligibility codes in the Medicaid "eMedNy" system. This FAQ explains that some codes may appear to say the individual is not eligible for Medicaid or for MLTC -- but THEY DO NOT MEAN THAT! And plan should submit "conversion package" to HRA to activate Medicaid and allow enrollment.

Special procedure for MLTC plans to submit "conversion" package to NYC HRA Medicaid program, to enroll residents of nursing homes who want to enroll in an MLTC plan in order to return to the community.

In all MLTC enrollments, the conversion package is a set of forms that HRA needs in order to make the necessary entries into the Medicaid eligibility and billing system, so that the enrollment takes effect on the 1st of the following month, and so the MLTC Plan is paid its capitation rate. Once in MLTC, the member will not be able to access Medicaid services in the MLTC service package outside the MLTC Plan's network.

For nursing home residents, the "conversion" is more complicated. HRA not only has to enter the codes described above but also has to remove the codes that applied because of the residence in the nursing home. For many years, nursing home residents have encountered delays in lifting the nursing home "code" from their eligibility, so that they could now access community-based home care and other medical services. The conversion package must include:

(1) The HCSP-3022 (Medicaid Cover Sheet) - This is the conversion form.. A copy is or will be posted on this website.
(2) Completed Nursing Home discharge Alert (MAP-259D)(posted at http://www.wnylc.com/health/download/132) and see article at http://www.wnylc.com/health/entry/117/ )
(3) A copy of the signed enrollment form
(4) A copy of the MAP-3057 (Special Income Standard) form, if applicable (posted at http://www.wnylc.com/health/download/398/) and described in http://www.wnylc.com/health/entry/114/ - last link in Table of Contents

8-13-13 MICSA Alert detailing the housekeeping conversion process to facilitate consumer disenrollment from MLTC plans to HRA.

NYLAG training materials, including PowerPoint and Appendix, on Medicaid Managed Long-Term Care in New York. As of 6/21/2013, the latest version of the presentation given by the Evelyn Frank Legal Resources Program 50 times in the last year.

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.