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Transferring from Medicaid Managed Care to a MLTC Plan

DOH has issued MLTC Policy 14.01 governing transfers from mainstream Medicaid Managed Care (MMC) to Managed Long Term Care (MLTC).  It specifies that a non-dually eligible (Medicaid-only) individual enrolled in a MMC plan may dis-enroll and enroll in a MLTC plan if the member requires one or more of three services available in MLTC but not provided by MMC plans.  These services are: Home delivered or congregate meals, social day care services, and social and environmental supports.  To transfer, the enrollee must provide a letter or referral from a practitioner indicating that the service is required.

An individual enrolled in MMC may also transfer to MLTC if he or she becomes eligible for Medicare and meets the MLTC enrollment criteria listed in the policy document. 

The policy does not affect a non-dual recipient’s right to initially choose a MLTC plan instead of a MMC plan if qualified for enrollment. However, once the recipient has elected to enroll into a MMC plan, policy 14.01 applies.  All plans are precluded from marketing to individuals who are already enrolled in a managed care plan.

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