MLTC – Managed Long-Term Care – What You Need to Know

Welcome back to the Prestige blog! We aim to use this blog to help readers better understand the home healthcare system, from all angles. Whether you are a person in need of home care, a family member who is considering home care options, a home care business owner, or a caregiver, we hope to provide insightful information to make better decisions. Depending on where you live, your state may have different terminologies and regulations, so we will focus on areas where we have a presence, but if you ever have a specific question about your area, you can always reach out to speak with someone from our team.

Today on the blog we want to go over some fundamental language that folks in New York may need to understand.

Managed Long Term Care is a common acronym you’ll see in the home healthcare industry, so let’s take a few minutes to break it down for folks seeking more information about home care.

  • What Is Managed Long-Term Care?
  • Who Must Join an MLTC Plan?
  • The 3 Types of MLTC Plans

What is Managed Long-Term Care?

A Managed Long Term Care (MLTC) Plan is a Medicaid plan for people with Medicare and Medicaid, or Medicaid only, who need community based long term care services and supports (CBLTSS). Each MLTC plan has its own network of service providers, who must be seen to get the plan’s services. You will have a Care Manager, who will help you get the services you need.

Who Must Join an MLTC Plan?

Depending on individual circumstances, enrollment in an MLTC plan may be mandatory or voluntary.

Enrollment in an MLTC plan is mandatory for those who:

– Are dual eligible for both Medicare and Medicaid, and over 21 years of age, and need community-based long-term care services for over 120 days

– Reside in the following counties:

  • Effective 2012-2013 – NYC, Albany, Erie, Monroe, Nassau, Onondaga, Orange, Rockland, Suffolk & Westchester
  • Effective 2014 – Broome, Cayuga, Chenango, Columbia, Cortland, Delaware, Dutchess, Fulton, Genesee, Greene, Herkimer, Livingston, Madison, Montgomery Niagara, Oneida, Ontario, Orleans, Oswego, Otsego, Putnam, Rensselaer, Saratoga, Schenectady Schoharie, Steuben, Sullivan, Tioga, Tompkins, Ulster, Washington, Warren, Wayne, Wyoming
  • Effective 2015 – Allegany, Cattaraugus, Chautauqua, Chemung, Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, St. Lawrence, Seneca, Schuyler, Yates

Enrollment in an MLTC plan is voluntary for those who:

– Are dual eligible and are 18-21 years of age and need community based long term care services for more than 120 days and asses as nursing home eligible

– Are non-dual eligible and over 18 years of age and are assessed as nursing home eligible.

The Three Types of MLTC Plans

All MLTC plans provide Medicaid home care and other community based long term care services and supports. Some MLTC plans also cover Medicare services, including doctor office visits, hospital care, and pharmacy, amongst other health-related services. There are three different types of MLTC Plans:

1. Medicare Advantage Plus (MAP)

2. Program of All-Inclusive Care for the Elderly (PACE)

3. MLTC Medicaid Plan

We will continue to break down the three types of MLTC plans and more about plans available in New York, as well as other areas around the country. Remember, each state has different terms and definitions, but if you are in NY, you can call to speak with someone here at Prestige about any questions you may have about home health care. We are more than willing to help! In addition, if you are a home care owner in NY, and are facing challenges with the current MLTC billing landscape, let’s get in touch and see how we may be able to help you!

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