MLTC Implementation Advisory Group

During a Managed Long Term Care (MLTC) implementation conference call on Fri., Sept. 20, the Department of Health (DOH) advised the group that they had received approval from the Centers for Medicare and Medicaid Services (CMS) to begin the mandatory enrollment process to MLTC in Orange and Rockland counties effective Sept. 30. In addition, DOH stated that they were on schedule to implement mandatory enrollment in MLTC in Albany, Erie, Onondaga and Monroe counties effective Dec. 1, 2013.

As of these effective dates, any individuals within these counties who are dually eligible (Medicare and Medicaid),  21 years of age or older and have received community-based long term care for 120 days or more, will begin to receive announcement letters regarding the change to MLTC. In addition, individuals who are new to Medicaid in these counties, 21 years of age or older, dually eligible and in need of community-based long term care for more than 120 days, will be referred to the enrollment broker for educational material and a list MLTC plans operating in these counties from which they may select a plan.

Approximately 30 days after the announcement letters are sent out, eligible individuals will receive a mandatory enrollment package. This package includes a letter, a detailed guide and lists of MLTC plans available in the area, as well as numbers to call for enrollment and/or questions. Individuals have 60 days to select a plan, and they will receive a reminder to enroll midway in that 60-day period. Individuals who do not enroll within 60 days will be auto-assigned to a MLTC. To date, DOH has sent out 100,000 pieces of communication including announcement letters, mandatory enrollment packages etc. Four thousand five hundred individuals have been auto-assigned to plans.

Long term CHHA cases, over 120 days of care, in NYC, Westchester and Long Island will receive letters about enrolling in a MLTC plan.

DOH plans on releasing the policy and GIS on spousal impoverishment budgeting for MLTC enrollees sometime this week; it's under the last final review and approval for clearance.   

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871