Page Reviewed / Updated - Jan. 2016
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. Instead, they remain 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: Managed Medicaid Long Term Care, Medicare Program for All-Inclusive Care for the Elderly (PACE), or Medicaid Advantage Plus.
In addition to other supports, 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.
There are 4 layers of eligible requirements for MLTC: age, location, disability, and financial. Applicants must be at least 65 years of age (except for the PACE Plan) and live in (or move to) one of 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. Effective January 1, 2016, one person can have monthly income of no greater than $825 and two people, $1,209. Their financial resources must be less than $14,850 for individuals and $21,750 for couples. Their home is not included in the sum of their financial resources unless it is not owner-occupied, or if the value of the home and real estate exceed $828,000.
New Yorkers whose income or assets surpass 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 all of 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.
This program is not yet available statewide. At the time of writing, it was available in the counties listed below. However, the intention is to become statewide, therefore if one's county is not listed below, it is recommended to 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.