"Batch" MLTC Disenrollment of Nursing Home Residents Effective Feb. 1st
The Department of Health (DOH) has initiated a "batch" disenrollment from partially capitated Managed Long Term Care (MLTC) plans for long-term nursing home residents. The disenrollments will take effect Feb. 1, 2024. The batch disenrollment process is triggered by the three-month nursing home benefit limitation under partially capitated MLTC. It applies to nursing home residents, enrolled in partially capitated MLTC plans, who:
- are designated as long-term nursing home stay (LTNHS);
- have been in a LTNHS for more than three months (LTNHS 3+); and
- have been determined by the local social services district to be financially eligible for nursing home Medicaid coverage.
Nursing home residents who are disenrolled from an MLTC plan as a result of the benefit limit will revert to fee-for-service Medicaid. More information for nursing homes is available in a Dear Administrator Letter (DAL) (available here).
DOH has instructed MLTC plans to immediately notify the MLTC Technical Assistance Center (TAC) of any MLTC members who have a pending Feb. 1st disenrollment and have had a change in status in the nursing home from long term care to temporary or long term care to community resident. The MLTC TAC will work to ensure that proper transitions of care or enrollment reinstatements occur, as needed.
In addition, MLTC enrollees may contact NY Medicaid Choice (NYMC) to avoid disenrollment if:
- they request an assessment to determine if they can safely return to the community;
- they are involved in the appeal process for home care services.
Questions may be submitted to the MLTC TAC here.
Contact: Karen Lipson, klipson@leadingageny.org