Senior Living Options

June 29, 2024

11 minutes

Navigating the Care Maze: Exploring Managed Long Term Care in NY

Discover managed long term care in NY. From enrollment to services covered, navigate the care maze with ease.

Understanding Managed Long Term Care

When it comes to long-term care for individuals who are chronically ill or disabled and prefer to remain in their homes and communities, managed long term care (MLTC) plays a crucial role. Managed Long Term Care in New York aims to streamline the delivery of long-term services, ensuring that individuals receive the necessary health and social services for an extended period.

What is Managed Long Term Care?

Managed Long Term Care (MLTC) refers to a system in New York that provides comprehensive long-term services to individuals who require ongoing care due to chronic illness or disability. The services covered by MLTC plans include home care, adult day care, and various other services necessary for those in need of long-term care.

The primary goal of MLTC is to enable individuals to receive the care they need while remaining in their homes and communities, rather than transitioning to a nursing home or other institutional setting. By consolidating and coordinating the provision of services through managed care plans, MLTC ensures that individuals receive the necessary support to maintain their independence and quality of life.

Benefits of Managed Long Term Care

Managed Long Term Care plans offer several benefits for individuals in need of long-term care services. These benefits include:

Comprehensive Services: MLTC plans provide a wide range of services to enrolled members, allowing them to receive all entitled services through their chosen MLTC plan. These services include home care, adult day care, and various other services for those in need of long-term care.
Flexibility and Choice: MLTC plans give individuals the flexibility to choose the services and providers that best meet their needs. Enrollees have the freedom to select from a network of approved providers, ensuring that they receive care from trusted professionals.
Care Coordination: MLTC plans assign care coordinators to help individuals navigate the complexities of long-term care. Care coordinators work closely with enrollees and their families to develop personalized care plans, ensure access to necessary services, and coordinate the delivery of care.
Continuity of Care: MLTC plans prioritize continuity of care by coordinating the various services and providers involved in an individual's care. This helps to ensure seamless transitions between different care settings and promotes effective communication among all parties involved in the individual's care.

By embracing managed long term care, individuals can receive the comprehensive and coordinated support they need to maintain their well-being and independence while remaining in their homes and communities. The MLTC system in New York provides a framework for delivering long-term services efficiently and effectively, meeting the unique needs of individuals requiring ongoing care.

Enrolling in Managed Long Term Care

When considering managed long-term care (MLTC) in New York, it is important to understand the enrollment process and eligibility criteria. Enrollment in MLTC can be either mandatory or voluntary based on individual circumstances.

Eligibility for Managed Long Term Care

Eligibility for MLTC is determined by the need for long-term care services. In New York, enrollment in MLTC is mandatory for individuals who require community-based long-term care services. This includes individuals who need assistance with activities of daily living, such as bathing, dressing, or meal preparation. It is also mandatory for those who require long-term care services in a nursing home.

For individuals in receipt of services from the Office for People with Developmental Disabilities or the Office of Mental Health, enrollment in MLTC is voluntary.

Mandatory vs Voluntary Enrollment

In New York City (NYC), mandatory enrollment in MLTC applies to all dual-eligible individuals aged 21 or older who require community-based long-term care services for more than 120 days. This initiative is part of the Medicaid Redesign Team Initiative #90 and amends the Partnership Plan Medicaid Section 1115 Demonstration waiver [3]. The transition process for individuals currently receiving Medicaid community-based care services into MLTC will occur over time, with information provided by Medicaid Choices, the Department's Enrollment Broker, on necessary steps and plan selection.

Mandatory enrollment will begin in NYC and then continue across the state as MLTC plan capacity is developed. The next set of counties for enrollment includes Nassau, Suffolk, and Westchester, with the transition process scheduled to begin in January 2013.

Understanding the eligibility requirements and whether enrollment is mandatory or voluntary is crucial when considering managed long-term care in New York. It is important to consult with the relevant authorities and resources to determine the specific enrollment process and options available based on individual circumstances.

Services Covered by Managed Long Term Care

Managed Long Term Care (MLTC) plans in New York provide a comprehensive range of services to enrolled members, ensuring that individuals in need of long-term care receive the necessary support. The services covered by MLTC plans may vary depending on the chosen plan and availability in the specific area. Care managers play a crucial role in coordinating the services covered by the plan with those that are not covered, ensuring that individuals receive the care they require.

Home Care Services

Home care services are a vital component of Managed Long Term Care plans. These services aim to assist eligible elderly or disabled individuals in remaining at home instead of moving into a nursing home. Home care programs in New York are Medicaid-funded long-term care programs, and eligibility requirements are typically linked to Medicaid eligibility.

Home care services provided under MLTC plans can encompass a range of supports, including:

Personal care assistance, such as help with bathing, dressing, and grooming
Assistance with activities of daily living, such as meal preparation and medication management
Skilled nursing care, including wound care or administration of medications
Physical, occupational, or speech therapy services
Home health aide services
Medical supplies and equipment necessary for home care

Adult Day Care Services

Managed Long Term Care plans also cover adult day care services, which provide a structured and supportive environment for individuals who require supervision and assistance during the day. Adult day care programs offer a range of services tailored to the needs of participants, promoting social engagement, cognitive stimulation, and physical activities.

The services provided in adult day care programs may include:

Supervision and assistance with activities of daily living
Socialization opportunities
Recreational and therapeutic activities
Nutritious meals and snacks
Medication management
Health monitoring and support

Adult day care services can be beneficial for individuals who require companionship and supervision during the day while allowing them to return to their homes in the evenings.

Ancillary Services

In addition to home care and adult day care services, Managed Long Term Care plans may include coverage for various ancillary services that support the overall well-being of enrolled members. These services are designed to address specific needs and enhance the quality of life for individuals requiring long-term care.

Examples of ancillary services covered by MLTC plans include:

Transportation assistance for medical appointments and other necessary trips
Nutritional counseling and meal planning
Caregiver support services, including respite care and training
Home modifications or assistive devices to improve accessibility and safety
Case management and care coordination
Behavioral health services, including counseling and therapy

The availability of ancillary services may vary depending on the specific MLTC plan and the needs of the individual. Care managers work closely with enrollees to determine the most appropriate services to meet their unique requirements.

By providing a comprehensive array of services, Managed Long Term Care plans aim to support individuals in need of long-term care, enabling them to receive the necessary assistance while maintaining their independence and improving their overall quality of life.

Managed Long Term Care Plans

Managed Long Term Care (MLTC) plans play a pivotal role in arranging and financing various health and long-term care services for individuals who require comprehensive care. In New York, there are two primary models of managed long-term care: Programs of All-Inclusive Care for the Elderly (PACE) and Managed Long-Term Care Plans.

Programs of All-Inclusive Care for the Elderly (PACE)

Programs of All-Inclusive Care for the Elderly (PACE) are tailored to individuals aged 55 and older who are eligible for nursing home admission. PACE organizations provide comprehensive coverage under the supervision of healthcare professionals. These programs offer a wide range of services, including medical care, long-term care, and support services necessary to maintain participants' independence and quality of life. PACE services are covered by both Medicare and Medicaid on a capitated basis.

Managed Long-Term Care Plans

Managed Long-Term Care Plans, the second model of managed long-term care in New York, cater to individuals who require long-term care services and ancillary services. While some plans may enroll younger members, the majority require enrollees to be at least 65 years old. These plans provide comprehensive coverage for various services, including home care, adult day care, nursing home care, and ancillary services such as dentistry and medical equipment. Payments for these services are received through Medicaid.

Members of Managed Long-Term Care Plans utilize their primary care physicians and inpatient hospital services by using their Medicaid and/or Medicare cards. These plans ensure that individuals receive the necessary care and support while maintaining their independence and well-being.

Understanding the different managed long-term care plans available can help individuals and their families make informed decisions regarding their long-term care needs. It is essential to assess the specific services and benefits provided by each plan to find the one that best suits an individual's unique requirements and preferences.

Transitioning to Managed Long Term Care

When it comes to transitioning to managed long term care (MLTC) in New York, there are specific processes and expansions to be aware of. Let's explore the transition process in New York City (NYC) and the expansion to other counties.

Transition Process in New York City

In New York City, individuals who are dual-eligible for Medicare and Medicaid and in need of community-based long-term care services for more than 120 days are required to enroll in Partial MLTCPs or Care Coordination Models. This initiative is part of the Medicaid Redesign Team Initiative #90 and amends the Partnership Plan Medicaid Section 1115 Demonstration waiver. The transition of individuals currently receiving Medicaid community-based care services into MLTC will occur over time. Necessary steps and plan selection information will be provided by Medicaid Choices, the Department's Enrollment Broker.

Expansion to Other Counties

After the transition process in New York City, the mandatory enrollment for individuals needing community-based long-term care services for more than 120 days will extend to other counties in New York. The next set of counties scheduled for enrollment includes Nassau, Suffolk, and Westchester, with the transition process set to begin in January 2013. The Department received approval from CMS (Centers for Medicare & Medicaid Services) to transition and enroll dual-eligible individuals aged 21 or older who need community-based long-term care services for more than 120 days into MLTC plans or Care Coordination Models in New York City. This requirement applies to all dual-eligible individuals in NYC, with further expansion planned to Nassau, Suffolk, and Westchester counties.

As the transition process continues, it is important to stay informed about the specific requirements and timelines for enrolling in managed long term care in different areas of New York. The New York State Department of Health and Medicaid Choices provide valuable resources and information to guide individuals through the transition and enrollment process.

Language Access in Managed Long Term Care

Ensuring effective communication and language access is essential in providing managed long term care (MLTC) services in New York State. MLTC plans recognize the importance of overcoming language barriers and take steps to make their services accessible to individuals with limited English proficiency. This section explores the language access provisions in MLTC.

Bilingual Staff and Written Materials

MLTC plans in New York State generally have bilingual staff members who can communicate with individuals who do not speak English fluently. These staff members can assist in explaining the MLTC program, answering questions, and providing support throughout the enrollment and care coordination process. This is crucial in ensuring that individuals can fully understand and participate in their care.

In addition to bilingual staff, MLTC plans also provide written materials in multiple languages. These materials include information about the MLTC program, rights and responsibilities, and other relevant topics. By offering written materials in various languages, MLTC plans aim to ensure that individuals have access to important information and can make informed decisions about their care.

Oral Translation Services

MLTC plans go beyond bilingual staff and written materials by offering oral translation services at no cost. These services enable individuals with limited English proficiency to communicate effectively with MLTC staff and providers. Whether it's during enrollment, care coordination meetings, or discussions about treatment options, oral translation services bridge the language gap and ensure that individuals receive the information they need to make informed decisions about their long-term care.

By providing bilingual staff, written materials in multiple languages, and oral translation services, MLTC plans strive to eliminate language barriers and ensure that language is not a barrier to receiving the necessary long-term care services. Plans may also have information on providers who speak languages other than English, further facilitating effective communication and care coordination.

Language access is a fundamental aspect of MLTC in New York State, enabling individuals with limited English proficiency to fully engage in their care and make informed decisions.

Changes in Managed Long Term Care

As the Managed Long Term Care (MLTC) system in New York unwinds from the COVID-19 Public Health Emergency, there are notable changes taking place. Two significant changes to be aware of are the resumption of involuntary disenrollments and the coverage of dental services.

Resumption of Involuntary Disenrollments

Following the regular rules post the Public Health Emergency, the MLTC plans have resumed involuntary disenrollments. This resumption includes plans such as Partial Capitation, Medicaid Advantage Plus (MAP), and Programs of All-Inclusive Care for the Elderly (PACE). Guidelines have been released through MLTC Policy 23.03 to ensure compliance with the MLTC contractual requirements post the emergency. The deadline for the submission of required documentation is set for December 1, 2023, and beyond.

Coverage of Dental Services

Another change in managed long-term care in New York is the coverage of dental services. Dental care plays a crucial role in maintaining overall health and quality of life. MLTC plans now offer coverage for dental services, ensuring that individuals receive comprehensive care to support their oral health needs.

The inclusion of dental services within the MLTC plans allows individuals to access preventive treatments, restorative procedures, and other necessary dental care. This coverage acknowledges the importance of oral health in overall well-being and ensures that individuals receiving managed long-term care have access to the dental services they require.

By staying informed about these changes in managed long-term care, individuals can better navigate the system and make informed decisions regarding their care. It is important to consult the MLTC guidelines and policies to understand the specific details and requirements related to the resumption of involuntary disenrollments and the coverage of dental services. The New York State Department of Health and the MLTC plans themselves can provide further information and support regarding these changes [2].

Resources for Managed Long Term Care

When navigating the realm of Managed Long Term Care (MLTC) in New York, it's essential to be aware of the available resources that can provide guidance and support. Here are two key resources that can assist individuals in understanding and accessing MLTC services:

New York State Department of Health

The New York State Department of Health (NYSDOH) plays a vital role in overseeing and regulating the MLTC program. Their website serves as a comprehensive resource for information on MLTC, eligibility requirements, covered services, and more. By visiting the NYSDOH website, individuals can access up-to-date information and gain a deeper understanding of the MLTC system.

Medicaid Choices and Enrollment Broker

The Medicaid Choices and Enrollment Broker is another valuable resource for individuals seeking MLTC services. This program assists individuals in understanding their options, determining eligibility, and selecting an MLTC plan that best meets their specific needs. Through the Medicaid Choices and Enrollment Broker, individuals can receive personalized guidance and support throughout the enrollment process, ensuring a smooth transition into the MLTC program.

By utilizing these resources, individuals can access the necessary information and assistance required to make informed decisions regarding MLTC. Whether it's understanding the eligibility criteria, exploring available services, or selecting an appropriate MLTC plan, the New York State Department of Health and the Medicaid Choices and Enrollment Broker are invaluable sources of information and support.