When it comes to finding the best long term care option for yourself or your loved one, it’s hard to know where to start. New York State offers residents options for managed long term care. This article explains what managed long term care is, who needs it, the plan options that are available, and your responsibilities under managed long term care.
Understanding Managed Long Term Care (MLTC)
In order to understand what managed long term care or MLTC is, it’s helpful to learn what long term care is. Long term care is care that you or your loved one need on an ongoing basis like needing help bathing, getting dressed, or cleaning your home among others. MLTC is a type of insurance that covers the cost of these services for the elderly and disabled people. In New York state, people often receive long term care through Medicaid. There are also options for those who have Medicare.
MLTC is a special type of health insurance that only covers long term care services. In order to receive it, you must belong to a health insurance provider like Medicare or Medicaid who offers long term care as part of its plan.
How Does Managed Long Term Care Work?
In New York State, enrollment in MLTC is mandatory or voluntary depending upon your individual circumstances. People are required to enroll in MLTC if they:
- Are eligible to receive Medicare and Medicaid, are over the age of 21, and need more than 120 days of community-based long term care services.
- Reside in NYC counties or the counties of Westchester, Nassau or Suffolk.
MLTC generally only becomes an option for people who are not required to enroll if they need 120 days (5 months) of services or more.
There are three programs offered by the state for managed long term care. These programs cover services such as:
- Adult Day Care
- Home Care
- Transportation Services
- Nursing Home Care
- Medical Supplies
Depending on the plan you choose, you may receive additional benefits entitled to you under Medicare and Medicaid in the same plan.
Once you choose a managed long term care plan , a case manager is assigned. The case manager will communicate with you at least twice a year. Their primary job is to answer any questions or concerns you might have so you may talk with them more frequently.
What are the MLTC Plan Types?
The plans for MLTC fall under three programs.
All-Inclusive Care for the Elderly (PACE) is a comprehensive health insurance plan that includes Medicare and Medicaid benefits. People age 55 and older can sign up for a PACE program if it’s available in their area and they need a nursing home level of care according to state criteria. They must also sign the PACE enrollment agreements.
The PACE plan covers all of the services that fall under long term care including rehabilitation services, social services, and medical services. If Medicare does not already cover it, Medicaid will. These include meals, adult day care, and social work services. The PACE program you are enrolled in coordinates the services you receive either at home, at an adult day care center, or at an on-site clinic. PACE does have its own network of doctors that you must see.
Medicaid Advantage Plus is a plan similar to PACE. It covers the same types of services and adds coverage for prescription drugs. You can enroll in this plan type if you are eligible for Medicare and Medicaid and meet the state criteria for a nursing home level of care. In order to enroll, you must be in a Medicare MLTC and Medicaid MLTC simultaneously because the two plans work together to give you the MLTC plan benefits covered under each insurance. You will also have to choose a doctor who accepts this plan as your primary care doctor.
Medicaid Long Term Care Plan
The Medicaid Long Term Care Plan covers the same services as PACE and Medicaid Advantage Plus when it comes to long term care. However, it keeps long term care separate from Medicare. This allows you to keep seeing the doctor you already have and doesn’t require you to switch to a doctor in the care plan network.
Your Responsibilities Under MLTC
Regardless of the plan type you choose, you have certain responsibilities to meet under MLTC. This responsibilities include:
- Making sure you are using providers covered under your plan.
- Getting approval from your assigned case manager before using a service.
- Letting your case manager know when you’re going to be away.
- If you have a spend down, you are responsible for paying costs related to it to the plan.
Managed Long Term Care offers many benefits for those in need of nursing home-level care. New York State offers these plan types as a way of streamlining that care. To learn more about specific provider plans, visit the New York Department of Health.
For more guidance on Managed Long Term Care in the Greater New York area, call us and talk to an expert at 718-461-9602 or email us at [email protected].