Yes - Managed Long Term Care (MLTC) enrollment is mandatory in both Nassau and Suffolk counties for dual-eligible Medicaid recipients age 21 and older who need community-based long-term care services for more than 120 days. NYSDOH extended mandatory MLTC enrollment to Nassau, Suffolk, and Westchester counties beginning in the 2013 transition period, and that mandatory enrollment structure remains in effect. MLTC plans coordinate home care, adult day care, nursing home care, and related services through a single managed care plan rather than fee-for-service Medicaid.
The detail behind the program
MLTC surprises a lot of Long Island families who expect Medicaid home care to work like traditional fee-for-service Medicaid, where a home health agency simply bills Medicaid directly. In Nassau and Suffolk, that's generally not an option once someone needs more than 120 days of community-based long-term care; they must select and enroll in an MLTC plan, which then becomes the entity managing and authorizing services like home care, adult day care, and nursing home stays. There are three MLTC lines of business: Partial Capitation plans, Medicaid Advantage Plus (MAP), and PACE (Program of All-Inclusive Care for the Elderly), the last of which is jointly funded by Medicare and Medicaid for people 55 and older. Eligibility generally also requires being assessed as needing nursing-home-level care while still being able to remain safely at home at the point of enrollment.
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