Additional Involuntary Disenrollment Reasons Reactivated

To ensure that individuals enrolled in Managed Long Term Care (MLTC) plans were able to maintain access to health benefits during the pandemic, the State had suspended involuntary disenrollments. These disenrollments are currently being phased back in with the Department of Health (DOH) resuming two MLTC Involuntary Disenrollment Request Reasons effective for Jan. 1, 2022 and thereafter.

The current MLTC Involuntary Disenrollment Request Reasons now include:

Deceased
Moved Out of State
No Longer in Medicare Advantage Product (Resumed effective Oct. 1, 2021 and forward. Applies to Medicaid Advantage Plus (MAP) plans only)
Enrollee No Longer Resides in the MLTC Plan’s Service Area (Resumed effective Oct. 1, 2021 and forward)
Enrollee or Family Member Engages in Behavior that Seriously Impairs the Contractor’s Ability to Furnish Services (For reasons other than those resulting from Enrollee’s special needs. Resumed effective Jan. 1, 2022 and forward)
Enrollee Has Been Absent From The Plan’s Service Area For More Than 30 (or 90 days for one plan) Consecutive Days (Resumed effective Jan. 1, 2022 and forward)

The resumption policies and Maximus MLTC 2022 Involuntary Disenrollment processing schedule are available under the section titled Guidance Materials at this link.

LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841