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Managed Long Term Care Plans

The state’s Medicaid redesign efforts are making managed long term care (MLTC) the primary care model for Medicaid recipients who need community-based long term care services for 120 days or more. Medicaid recipients aged 21+ who need such care will be required to enroll into MLTC. For these Medicaid recipients, MLTC plans will take the lead in coordinating needed home and community based services, with actual services provided by a network of contracted providers. There are several types of MLTC plans: one type focuses on Medicaid services, while two other types cover and coordinate both Medicaid and Medicare services.

MLTC enables individuals whose continuing health care needs would qualify them for admission to a nursing home, or who are determined to need 120+ days of long term care services in the community, to remain in their home while receiving a broad array of customized services and supports. While most MLTC enrollees are eligible for both Medicaid and Medicare, people can pay out of their own funds and some long term care insurance coverage may be available.

The three types of MLTC in New York State are the Programs of All Inclusive Care for the Elderly (PACE), Medicaid Advantage Plus (MAP) plans and “Medicaid Only” or “Partially Capitated” MLTC Plans. Enrollees are assigned a care coordinator and use a team that may include physicians, therapists, nurses, social workers and home health aides to plan, provide and coordinate all needed services. Transportation to necessary medical services is part of the service package. Most organizations encourage the person and their family to be a part of the care planning process.

For each Medicaid and/or Medicare enrollee, the MLTC plans receive a fixed monthly premium which is used to provide a package of services tailored to an individual’s needs, including services that traditional Medicaid and Medicare do not provide. Compared to traditional Medicaid and Medicare, services are more coordinated and more customized, while out-of-pocket expenses are usually lower.

PACE seamlessly combines Medicaid and Medicare services. MAP plans integrate Medicaid and Medicare in a bit more complicated manner. “Medicaid Only” MLTC plans provide only Medicaid long term care services and help coordinating Medicare services for the enrollee. Therefore, it is important to review and understand the scope of services that each type of plan offers. All PACE plans have a day center and fully licensed clinic that participants use as needed while some other plans tend to rely more on home care. PACE participants must be at least 55 years old, while other plans enroll individuals as young as 18. The state has also launched Fully Integrated Duals Advantage (FIDA) plans in the downstate region that operate similar to MAP plans.