Major update - DOH Receives Written Approval from CMS for MLTC Mandatory Enrollment
September 2012
The Centers for Medicare and Medicaid Services (CMS) has provided DOH with the written approval for the federal 1115 waiver that makes Managed Long Term Care (MLTC) mandatory for dually eligible individuals over the age of 21 who receive community-based long term care in excess of 120 days. This approval also will provide dually-eligible individuals age 18-21, as well nursing home level of care individuals age 18 and older, the option to enroll into a MLTC.
This also clears the way for the auto-assignment process to begin for those recipients who do not voluntarily select an MLTC plan. DOH released additional information to clarify what auto-assignment means now that written approval has been received. Those recipients who received a letter on July 6 will now receive a notice of auto-assignment the first week in October with an effective enrollment date of Nov. 1. At any point in the process, even after they have received the notice of auto-assignment, they may select a plan and that enrollment will be effective with the next enrollment cycle.
NYC Human Resources Administration (HRA) published a Medicaid Alert on the Mandatory Enrollment into MLTC which spells out, among other important information, that HRA’s Home Care program will no longer accept new M11Qs for personal care from dually-eligible consumers age 21 and older effective Monday, September 17.
In the approval letter, CMS indicated that they look forward to working with DOH on the request to transition the state’s Section 1915 (c) waiver, the Long Term Home Health Care Program (LTHHCP) into the MLTC program once the waiver amendment is approved.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871