Page Reviewed / Updated - Feb. 2019
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 a nursing home. This includes persons with Alzheimer’s and other forms of dementia. Instead of being placed in a nursing home, they remain living at home or can receive care services in assisted living. By allowing individuals to do this, the state maximizes the use of family caregivers and lowers its institutional Medicaid costs.
NY's Managed Long Term Care consists of three Plans. Participants can select one of the following Plans: Medicaid Managed Long Term Care (MLTC), Medicare Program for All-Inclusive Care for the Elderly (PACE), or Medicaid Advantage Plus.
In addition to other supports, the Managed Medicaid Long Term Care Plan provides for personal care at home and in adult day care. Participants in this plan continue to receive medical services through Medicare. The Medicare PACE plan allows individuals who are 55 or older to receive their care through a medical team. The Medicaid Advantage Plus Plan is an inclusive and comprehensive option that provides both medical and long term care services.
In addition to being New York residents, there are three layers of eligible requirements for MLTC: age, disability / functional need, and financial.
Age - Applicants must be at least 65 years of age (except for the PACE Plan in which participants must be 55+).
Functional Ability - The disability requirement states applicants 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 himself/herself is necessary.
Financial - On the financial side, applicants’ income and assets must fall within New York's Medicaid limits. As of 2019, one person can have monthly income of no greater than $859 and two people, $1,267. Their financial resources must be less than $15,450 for individuals and $22,800 for couples. The home is not included in the sum of their financial resources unless neither spouse intends to live in it. Also, New Yorkers in areas of the state where real estate values are increasing rapidly should be aware that there is a limit of $878,000 on the equity value of their home.
New Yorkers whose income or assets surpass Medicaid's limit may still be able to receive some Medicaid benefits through Medically Needy 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 all the Plans within this managed care program receive the following services:
In addition, participants in the Medicare PACE and the Medicaid Advantage Plus Plans receive Medicare medical services, while those who opt for the MLTC Medicaid Plan continue to receive their medical benefits separately.
MLTC was previously available in only certain NY counties. However, this program is now available statewide in all 62 counties.
One can learn more by downloading the state’s consumer guide to MLTC, available here.
One can apply through any Local Department of Social Services. However, if one is uncertain if they meet New York’s strict Medicaid eligibility requirements, it is recommended they consult with a Medicaid planner prior to application. Depending on one’s specific situation, New York may offer alternative pathways towards Medicaid eligibility. Again, a Medicaid planner familiar with NY regulations can assist. Read more.