MLTC Implementation Update - Mandatory Enrollment Begins in Four Upstate Counties

The Department of Health (DOH) made several announcements during the MLTC Implementation Advisory call on Nov. 22 which included:

1. Mandatory enrollment for duals will begin the first part of December in the four upstate urban counties of Albany, Erie, Onondaga and Monroe. Those mandated to enroll in MLTC includes individuals currently receiving more than 120 days of community based long term care services. All those receiving service will be enrolled at the same time; the enrollment of the services will not be staggered. DOH reported approximately 5,000 Medicaid recipients will be affected.  

2. The same process as the downstate enrollment will be followed - those individuals currently receiving services in programs such as personal care, consumer directed personal assistance, Long Term Home Health Care Program, adult day health care, and private duty nursing will receive an announcement letter first than a letter that will ask the individual to chose a plan within 60 days.

3. New Medicaid recipients for the same services as above will be directed to enroll into a plan.

4. The "front door" to Medicaid fee-for-service for long term services will not be closed for new duals until the Local Departments of Social Services in the four counties are fully prepared for all of the changes.

5. In mid- December DOH plans to release the mandatory roll-out timetable for duals and other counties/services.

6. DOH did clarify no other mandatory enrollment will occur during the first quarter of 2014.

7. DOH also stated personal care providers who had their personal care recipients transition to MLTC must receive the HRA rate or local county rate until March 2014 in the mandatory counties.

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