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Certain MLTC Involuntary Disenrollments to Resume

As a result of the expiration of the state COVID-19 Public Health Emergency (PHE), the Department of Health (DOH) will begin reinstituting certain involuntary disenrollment processes prospectively, effective for disenrollment date of Oct. 1, 2021 and monthly thereafter. Managed Long Term Care (MLTC) plans may begin submitting disenrollments on Sept. 1, 2021 for the following two Disenrollment Reasons:

  • No longer in Medicare product (Enrollee is no longer a member of the plan’s Medicare Advantage Program)

Applicable to Medicaid Advantage Plus (MAP) plans. Requires submission of document proof from the Centers for Medicare and Medicaid Services (CMS) or the Electronic Provider Assisted Claim Entry System (ePACES) and expected disenrollment date. MAP plans submit the MLTC Involuntary Disenrollment Request Form to New York Medicaid Choice (NYMC).

  • Enrollee no longer resides in the plan’s service area

Applies to all MAP, Program of All-Inclusive Care for the Elderly (PACE), and MLTC Partial Capitation (MLTCP) plans. Requires evidence of consumer’s new residence. MAP, PACE, and MLTCP plans must submit the MLTC Involuntary Disenrollment Request Form to NYMC and include dates of when the New York City Human Resources Administration (HRA)/local department of social services (LDSS) was notified of the new address. Note: Residential Address must be updated by the LDSS in order for the disenrollment/transfer to be processed.

Members should review the letter sent out to plans on this matter and the corresponding disenrollment schedule, provided here. DOH will continue to evaluate resumption of other involuntary disenrollment reasons and will notify plans prospectively. If you have any questions about this matter, please contact mltcinfo@health.ny.gov.

Contact: Karen Lipson, klipson@leadingageny.org, or Meg Everett, meverett@leadingageny.org. Both can be reached at 518-867-8383.