Managed long-term care (MLTC) health plans provide services for some chronically ill New Yorkers and/or those with disabilities. MLTC plans are available on a regional basis to those who have Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). and Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. (dually eligible individuals) and require long-term care services and supports. MLTC is one of several demonstration programs across the country with the goal of providing better and more coordinated care for dually eligible individuals while reducing health care expenditures where possible. MLTC plans are approved by the New York State Department of Health. These plans provide coverage for a number of services, including:
- Home care (including personal care Personal care, also known as unskilled care, is assistance with activities of daily living. Providers of personal care (home health aides) are not required to undergo medical training. Medicare only covers personal care if you are homebound and receiving skilled care. and skilled nursing care)
- Adult day health care (medical only, or medical and social together)
- Home-delivered meals and congregate meals
- Medical equipment, durable medical equipment (DME) Durable medical equipment (DME), also known as DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) is equipment that primarily serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home; for example, wheelchairs, oxygen equipment, and hospital beds. Medicare only covers DME if your provider says it is medically necessary for use in the home. , eyeglasses, hearing aids, home modifications
- Non-emergency medical transportation
- Podiatry, audiology, dentistry, and optometry
- Physical, speech, and occupational therapy Occupational therapy is therapy that helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes.
- Nursing home A nursing home, also called a long-term care facility, is a residential facility for people with chronic illness or disability. Nursing home services include room and board, nursing care, personal care, and therapy services. A skilled nursing facility (SNF) is a nursing home that provides skilled care, but not all nursing homes are SNFs. Medicare does not cover the cost of nursing homes that are not SNFs. care
Note: Having an MLTC plan does not affect your Medicare. This means that Original Medicare or your Medicare Advantage Plan remains your primary payer, paying first for the care you get from hospitals, primary care doctors, and specialists. Your Medicare prescription drug coverage also remains unchanged.
MLTC eligibility
Enrollment in an MLTC plan is mandatory if you fulfill all of the following:
- Are 21 years or older
- Are dually eligible for both Medicare and Medicaid
- Require long-term care services and supports for more than 120 days
- Live in New York State
Enrollment in an MLTC plan is voluntary for:
- Dually eligible individuals age 18 to 20 who meet the other three above criteria
MLTC enrollment
If you want to learn if you meet the above eligibility requirements, are not yet receiving Medicaid managed long-term care, and are interested in joining an MLTC plan, you first must contact the New York Independent Assessor Program (NYIAP) at 855-222-8350. NYIAP will send a nurse to your home to perform an evaluation of your need for long-term care. The nurse will tell you by the end of your evaluation if you are eligible to join an MLTC plan.
After completing this evaluation, you have 75 days to join the MLTC plan of your choice. After 75 days, your evaluation expires and you must schedule a new visit from the NYIAP to be reassessed.
Note: NYIAP does not determine the services or level of care you will receive after enrolling in an MLTC plan. Rather, the plan you choose will make its own care determinations based on your specific needs.
FIDA ended in 2019
New York’s Fully Integrated Duals Advantage (FIDA) demonstration program ended December 31, 2019, for all enrollees. For information on your long-term care coverage options now that FIDA has ended, see our Medicare Interactive toolkit or contact the Independent Consumer Advocacy Network (ICAN).