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Changes Coming to Medicaid and Managed Long Term Care

If you are receiving Medicaid benefits in the community (ie, getting care at home), you are probably enrolled with a Managed Long Term Care (MLTC) provider.  The MLTC contracts with various home care agencies who provide the care.

As part of the 2018/2019 budget, the New York State Department of Health (overseers of the program) will enact a number of changes which could have a negative impact on individuals receiving care services.  Some of the changes:

  • Members who enroll in a new MLTC plan after December 1, 2018 will be “locked in” to that plan for 9 months after the first 90 days of being enrolled. In other words, you will not be able to change plans (and will therefore be stuck with a particular plan) after 90 days, for at least 9 months.
  • An individual who is “permanently placed” in a nursing home for 3 or more months will no longer be able to enroll in an MLTC plan. Similarly, someone who is already enrolled in an MLTC plan will be disenrolled after 3 months of permanent placement. This leads to concern that an MLTC may seek to have someone placed permanently in a nursing home instead of providing (paying for) significant care at home to save money.
  • Beginning in October, MLTC plans must reduce/limit the number of licensed home care agencies they contract with, raising concerns about people potentially losing aides they may have had for a long period of time and who they feel comfortable with if an agency will no longer have a contract with the MLTC.

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