DOH Preparing for Next Batch Disenrollment of MLTC Nursing Home Residents
(April 1, 2025) We remind nursing home members that the Department of Health (DOH) requests that providers submit information on any individuals who should not be disenrolled from their Partially Capitated Managed Long Term Care (MLTCP) plan as the state processes the next round of batch dis-enrollments of long-stay nursing home residents from MLTCP. The dis-enrollments will take effect June 1, 2025. Unless the individual is identified as working toward a return to the community or requests a fair hearing, residents meeting the criteria below will be transferred to Medicaid fee-for-service (FFS) effective June 1st:
- Resident is enrolled in an MLTCP plan;
- Resident’s status is identified as a long-term nursing home stay (LTNHS) (i.e., Local Department of Social Services (LDSS)-3559 or equivalent has been provided to the resident and submitted to LDSS); and
- Resident has been in a LTNHS for more than three months (LTNHS 3+).
DOH circulated the associated Dear Administrator Letter along with other materials through a direct e-mail on March 21st. To ensure that members who may be in the process of transitioning to the community are not disenrolled from their MLTCP plan, the Department is requesting that nursing homes use the template that was circulated with the notice to provide a list of their nursing home residents who have been designated LTNHS and who have an active discharge plan to transition to the community no later than Fri., Apr. 4th.
Homes that do not have any members who fit the above criteria of an active discharge plan are asked to notify the Department by sending an email to DOH.sm.MLTCNH@health.ny.gov indicating that they have performed the review and do not have any residents who meet the criteria.
This process does not impact rehabilitative, short-term, or temporary nursing home residents and does not impact residents who may be Program of All-Inclusive Care for the Elderly (PACE) participants, Medicaid Advantage Plus (MAP) members, or mainstream Medicaid managed care enrollees.
DOH is fielding questions at MLTCNH@health.ny.gov.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841