Page Reviewed / Updated - Mar. 2014
This Medicaid program is intended to help eligible seniors with chronic illnesses or disabilities that require the level of care typically provided in skilled nursing homes, yet who prefer to not live in residential care and instead to remain living at home. By allowing individuals to remain at home, the states maximizes the use of family caregivers and lowers its institutional Medicaid costs.
NY's Managed Long Term Care is similar to and often confused with Medicare PACE programs. While both programs provide comprehensive care coverage, there are 3 key differences. PACE programs are available to younger individuals; persons aged 55 can qualify. PACE is open to Medicare and Medicaid beneficiaries and finally PACE requires participants to use specific care providers.
As well as a variety of other supports, Medicaid Managed Long Term Care provides for personal care at home and in adult day care. In doing so, the program helps the elderly to avoid nursing home placement and helps families to care for loved ones in a home environment.
There are 4 layers of eligible requirements for MLTC: age, location, disability and financial. Applicants must be at least 65 years of age and live in one the NY counties in which the program is offered. The disability requirement states they must need the level of care provided in a skilled nursing home. From a practical standpoint, this means an assessment of the individual's ability to care for themselves is necessary.
On the financial side, their income and assets must fall within New York Medicaid limits. For 2013, one person can have a monthly income of no greater than $809 and two people, $1,192. Their financial resources must be less than $14,550 for individuals and $21,550 for couples. Their home is not included in sum of their financial resources unless it is not owner-occupied or if the value of the home and real estate is in excess of $813,000.
New Yorkers whose income or assets exceed Medicaid's limit may still be able to receive some Medicaid benefits through Spend Down. This exception considers the applicant's medical costs relative to their income.
Another option is to work with a Medicaid planning expert who assists families in structuring their income and resources in such a way as to qualify for Medicaid. By doing so, families who would not otherwise qualify, can gain eligibility as well as retain some of their life saving for future generations. Learn more.
Participants in this program can be approved for many different types of services such as:
At the time of writing, this waiver was available in the counties of Nassau, Rockland, Orange, Westchester, Schenectady, Oneida, Onondaga, Erie, Herkimer, Monroe, and the five NYC counties. Additional counties may have been added to the program, check the NY Department of Health website.
To apply, interested individuals should contact a provider in their area. A provider list is available for download here.