Managed long-term care might be the right option for you or a loved one. Read below for answers to frequently asked questions about the managed long-term care program.
Managed long-term care (MLTC) helps people who are chronically ill or have disabilities and who need health and long-term care services, such as home care or adult day care, stay in their homes and communities as long as possible. The MLTC plan arranges and pays for a large selection of health and social services, and provides choice and flexibility in obtaining needed services from one place.
There are two basic models of managed long-term care in New York State: Programs of All-Inclusive Care for the Elderly (PACE) and Managed Long-Term Care Plans.
A PACE organization provides a comprehensive system of health care services for members age 55 and older who are otherwise eligible for nursing home admission. Both Medicare and Medicaid pay for PACE services (on a capitated basis). PACE members are required to use PACE physicians and an interdisciplinary team develops care plans and provides on-going care management. The PACE is responsible for directly providing or arranging all primary, inpatient hospital and long-term care services required by a PACE member. The PACE is approved by the U.S. Centers for Medicare and Medicaid Services.
Managed long-term care plans provide long-term care services (like home health and nursing home care) and ancillary and ambulatory services (including dentistry, and medical equipment), and receive Medicaid payment. Members get services from their primary care physicians and inpatient hospital services using their Medicaid and/or Medicare cards. Members must be eligible for nursing home admission. While several plans in New York State enroll younger members, most managed long-term care plan enrollees must be at least age 65.
You are eligible to enroll in managed long-term care if you:
To begin the process of enrolling in a PACE or MLTC plan, you, or someone on your behalf (family, friend, doctor), contacts the plan in your area. A staff person from the plan makes one or more visits to your home before you join to:
If you are currently receiving Medicaid and/or Medicare services, you still receive the same types of services usually paid for by Medicaid and Medicare. You do not lose any of your regular Medicaid or Medicare benefits. If the Medicare or Medicaid service is not covered by the plan, you may still receive the service outside the plan using your Medicare or Medicaid card.
On August 31, 2012, the Department received written approval from CMS to move forward with Medicaid Redesign Team Initiative #90 and to fully implement the transition and enrollment of recipients requiring community-based long term care into Managed Long Term Care Plans or Care Coordination Models beginning in New York City (NYC). This initiative amends the Partnership Plan Medicaid Section 1115 Demonstration waiver to require all dual-eligible individuals (persons in receipt of both Medicare and Medicaid) who are aged 21 or older and are in need of community-based long term care services for more than 120 days to be enrolled into Partial MLTCPs or CCMs. If you are a Medicaid recipient in NYC who meets the criteria above you must receive those services through a MLTC plan. Individuals who are presently receiving Medicaid community-based care services will be transitioned into MLTC over time. These individuals will receive information from Medicaid Choices, the Department's Enrollment Broker about what consumers need to do and how to select a Plan. This mandatory enrollment for will continue throughout the State as Plan capacity is developed. The next set of counties include: Nassau, Suffolk, and Westchester scheduled at this time for January 2013 to begin the transition process.
No. Language is not a barrier to receiving managed long-term care services. Most plans have bi-lingual staff and written materials are prepared in several languages. Oral translation services are available from each managed long-term care plan free of charge. Each plan has the names, locations and telephone numbers of providers who speak languages other than English. Contact the plan in your area to get this information.