Voluntary Enrollment into MLTC for Individuals Not Eligible for Medicare

The Department of Health (DOH) has circulated a draft policy that would revise and clarify the process used when an enrollee of a Medicaid Managed Care (MMC) Plan who is not eligible for Medicare wishes to voluntarily enroll into Managed Long Term Care (MLTC) to access a service not available in their plan. These services include social day care and, until Community First Choice Option (CFCO) services are added to MMC, home delivered meals and social/environmental supports.

The draft policy, available here, details the responsibilities for the transferring and receiving plans as well as for the State’s enrollment broker, New York Medicaid Choice (NYMC), and the Conflict Free Evaluation and Enrollment Center (CFEEC). The policy specifies that once CFEEC determines the individual is eligible, NYMC will conduct a warm transfer by phone to the selected MLTC plan. The plan has 30 days to perform an assessment. If the individual agrees with the resulting plan of care, the MLTC plan must accept the enrollment and conduct a three-way call with the enrollee and NYMC to confirm the transfer. The potential enrollee may withdraw the transfer request at any time during the process.

Upon final approval and issuance to MMC plans and MLTC plans, this policy will supersede the May 9, 2016 “Dear Health Plan” letter which provided guidance to health plans regarding the transition of non-dual MMC plan members that have expressed an interest in voluntarily enrolling into an MLTC plan.

Please review this draft and provide comments to us or directly to DOH at omcmail@health.ny.gov no later than Sept. 6, 2019. Please use “Voluntary Transfers Non-Duals MMC Plan to MLTC Plan Policy” in the subject line of your response.

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