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Medicaid Choice: The New Medicaid Managed Long-Term Care Program effective 9/17/12

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The Federal Medicaid Agency (CMS) has given approval to a big change in how the New York State Medicaid Program determines the need for and delivery of personal care services.  Personal care services are broken down into both "home attendant" services and "housekeeping" services.  These changes will be effective as of September 17th for all new applications for Medicaid home care services; existing Medicaid home care recipients will have to convert over to the new program in October of 2012.  These changes will start in New York City, then onto Long Island and finally onto Westchester.

What does this mean for the average Medicaid applicant/recipient?
The Medicaid home care program will be converted over to an HMO model - also know as a capitated medical program.  Under this new Managed Long Term Care (MLTC) model, all MLTC plans will be paid a fix dollar each month to provide care for each Medicaid covered particpants.  For existing Medicaid home care recipients this change will require them to select a Managed Long Term Care Plan (MLTC Plan), and that plan will then provide them with all their home care services needs.  New applicants will be asked to select an MLTC Plan as their services provided at the time of application.  The new program name will be "New York Medicaid Choice".  There are no changes to the basic income and assets rules for establishing Medicaid eligibility.

Important dates and deadlines for current Medicaid home care recipients 
Starting in October 2012, New York Medicaid Choice will be sending out notices to all current Medicaid home care recipients.  These mailings will include and enrollment packet for choosing an MLTC plan.  A plan must be selected within 60 days, otherwise the Medicaid home care recipient will be randomly assigned to an MLTC plan. 

Important information for new home care applicants
New applications may be submitted directly to Medicaid or directly to an MLTC plan - however, if you apply directly to Medicaid,  you will later need to apply to an MLTC plan once Medicaid had determined your eligibilty for home care coverage.  The "Medical Request for Home Care" form (known as the M11Q form) is no longer used in the application process for home care services.

The Long-Term Care Options: Choosing an MLTC plan  
There are three Managed Long-Term care models in New York State to choose from.  Here is a brief description of the three models; Medicaid home care applicants will be asked to choose a plan that falls into one of these basic models:

MLTC Medicaid Plans (Managed Long-Term Care Plans):

These plans provide long-term care services for those age 21 and older. These service plans include home health care, nursing and personal care.  Additionally, the MLTC plans will also provide ambulatory services that are medically necessary- ambulatory services include dental care and medical equipment.  MLTC members will continue to received medical services from their current Medicare doctors and the same in-patient hospital coverage under Medicare - only non Medicare services will be covered by Medicaid.  MLTC Medicaid Plan members will have two cards - a Medicare Card and a Medicaid card.

Medicaid Advantage Plus Plans:

These plans are available to consumers who are eligible for both Medicaid and Medicare, and who wish to have the same health care plan for most of the Medicaid and Medicare benefits under one roof.  Individuals enrolled in these plans will have "Medicare Advantage" for their Medicare services and "Medicaid Advantage Plus" for their Medicaid covered services.  To be eligible for Medicaid Advantage Plus plans the consumer must be eligible for nursing home level of care.  Members of these plans will have only one card for both their Medicare and Medicaid coverage.

PACE (Program for all inclusive care for the elderly):

These plans are open to those ages 55 and older, who are otherwise eligible for nursing home admission.  Both Medicaid and Medicare will pay for PACE services.  Members are required to use PACE doctors. PACE is responsible for arranging all primary care, in-patient hospital and long-term care services that are needed by a PACE member.

For help in choosing an MLTC provider click the link below:

Click here for NY Medicaid Choice Help

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