DOH Receives Approval for Mandatory Managed Long-Term Care - Healthcare Association of New York State

The Department of Health (DOH) received written approval from the Centers for Medicare and Medicaid (CMS) for a state plan amendment to require certain Medicaid consumers to enroll in Managed Long Term Care Plans (MLTCPs).  Consumers over age 21 with Medicaid and Medicare coverage who need more than 120 days of home- and community-based long-term care services will be enrolled in a managed long-term care plan over the next several years.  In addition, individuals age 18 to 21 who are eligible for both Medicare and Medicaid (dual eligibles) and nursing home-eligible, non-dual eligibles age 18 and older will have the option of enrolling in MLTC. 

DOH has indicated to HANYS that the receipt of CMS’ formal amendment approval now allows DOH to move forward with auto-enrollment of the target population.  DOH is partnering with stakeholders, local social services districts, and New York Medicaid Choice to launch the mandatory program, first in New York City, and will continue implementation statewide. Individuals in New York City, who received enrollment outreach letters on July 6, will receive a notice of auto-assignment the first week in October, with an effective enrollment date of November 1.  At any point in the process, even after Medicaid enrollees have received their notice of auto-assignment, they may select a plan of their choosing and their enrollment will be effective with the next enrollment cycle.

As MLTCPs prepare for the influx of new enrollees, plans must provide adequate access to services and care coordination by contracting with existing providers of community-based long term care services. Until DOH also receives formal approval from CMS to eliminate long-term home health care programs (LTHHCPs) in counties that require mandatory MLTC enrollment by amending its Section 1915(c) waiver, LTHHCPs will be allowed to accept new patients into service and participate in this transition.  This has been a topic of much discussion throughout the transition and DOH issued frequently-asked questions on August 16 and August 21 that address topics about statutory authority, the relationship of the transition to pending state waiver applications to CMS, and enrollees’ rights and information, including the impact of the transition on the future of existing programs like LTHHCPs.

DOH continues to hold bi-weekly implementation callsâ€"in which HANYS participatesâ€"to provide education and outreach to stakeholders and consumers, and will engage with local social services districts throughout the transition to mandatory Medicaid managed long-term care.

Members should submit questions to mltcworkgroup@health.state.ny.us, as DOH routinely adds to its list of frequently asked questions.  Contact: Debbie LeBarron