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DOH Issues Guidance for Transfer from Managed Care to MLTC

The Department of Health (DOH) issued a letter to Managed Long Term Care (MLTC) and Medicaid Managed Care (MMC) plans laying out the procedure that should be followed when an MMC enrollee eligible for Medicaid but not Medicare seeks to enroll voluntarily into an MLTC plan.  This scenario occurs when the enrollee desires, and a physician documents the need for, social day care, meals on wheels or social and environmental supports.  For the transfer to be made, the individual must be evaluated by the Conflict Free Evaluation and Enrollment Center (CFEEC) and found to require community based long term care services for more than 120 days and score five or higher on the Uniform Assessment System (UAS).  The letter is available here.

Contact:  Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841