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 and Medicaid (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 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), eyeglasses, hearing aids, home modifications
- Non-emergency medical transportation
- Podiatry, audiology, dentistry, and optometry
- Physical, speech, and occupational therapy
- Nursing home 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.
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
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 Conflict-Free Evaluation and Enrollment Center (CFEEC) at 855-222-8350. CFEEC will send a nurse to your home to perform a conflict-free evaluation. The nurse will assess your long-term care needs and tell you by the end of your evaluation if you are eligible to join an MLTC plan.
After completing this conflict-free 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 CFEEC to be reassessed.
Note: The CFEEC 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.
MLTC and the FIDA program
If you have an MLTC plan and live in New York City, Nassau County, Suffolk County, or Westchester County, you are eligible to join the Fully Integrated Duals Advantage (FIDA) program. Through FIDA, you will receive your Medicare and Medicaid benefits, including long-term care, from one plan.
Remember, enrollment in FIDA is not required, and you can disenroll from your FIDA plan at any time. To disenroll from a FIDA plan, call New York Medicaid Choice at 888-401-6582, TTY 888-329-1541.
If you are experiencing problems with the CFEEC assessment, coverage under your MLTC or FIDA plan, or need help navigating your options, please contact the Independent Consumer Advocacy Network (ICAN) at 844-614-8800.