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

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.

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.

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

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.

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

NYLAG Comments on Proposed Changes in 1115 Waiver Governing MLTC to Impose "LOOKBACK" for Communiity Based Long Term Care. The waiver document is posted here https://health.ny.gov/health_care/medicaid/redesign/mrt2/proposals/mltc_elig_vol_enroll_duals.htm

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

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.

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/