Program Description
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 not to 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: Managed Long Term Care (MLTC) Medicaid Plan, Program for All-Inclusive Care for the Elderly (PACE), or Medicaid Advantage Plus (MAP).
In addition to other supports, the MLTC Medicaid Plan provides for personal care at home and in adult day care. While this program is separate from Medicare, participants in this plan continue to receive medical services through Medicare. The 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. To be clear, for both PACE and the Medicaid Advantage Plus Plan, program participants receive both Medicare and Medicaid services.
New York State Residents cannot concurrently enroll in a MLTC Plan and the NY Assisted Living Program, other Long Term Home Health Care Program waivers, or hospice services.
Eligibility Guidelines
New York residents who are 21 years of age or older, are dual eligible (qualify for both Medicare and Medicaid), and have a need for long-term care for more than 4 months are required to enroll in a NY Managed Long Term Care Plan. In addition to the mandatory enrollment criteria, there are three layers of eligible requirements for MLTC: age, disability / functional need, and financial.
Age – Applicants must be at least 21 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, senior applicants’ income and assets must fall within New York’s Medicaid limits. As of 2022, one person can have monthly income of no greater than $934 and a married couple with both spouses as applicants, $1,367. Their financial resources must be less than $16,800 for individuals and $24,600 for couples. When only one spouse requires MLTC services, the non-applicant spouse may be allotted a greater portion of the couple’s income and assets in order to prevent spousal impoverishment. In 2022, an applicant spouse may transfer up to $3,435 / month in income to the non-applicant spouse as a monthly maintenance needs allowance (to bring the non-applicant spouse’s income up to this level). The non-applicant spouse may also be able to retain up to $137,400 of the couple’s joint assets as a community spouse resource allowance, which is an addition to the $16,800 the applicant spouse is able to keep. (Click here to learn more about Medicaid and jointly owned assets).
Please note that 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 $955,000 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.
Benefits and Services
Participants in all the Plans within this managed care program may receive the following services:
- Adult Day Health / Social Care
- Care Management
- Chore Service and Housekeeping
- Congregate and Home Delivered Meals
- Dental Services
- Durable Medical Equipment
- Home Care and Home Health Care
- Home Modifications
- Medical Social Services
- Non-Emergency Medical Transportation
- Nutrition Counseling
- Occupational, Physical and Speech Therapies
- Personal Care Assistance (Self Directed via the Consumer-Directed Personal Assistance Program)
- Personal Care Services in Assisted Living
- Personal Emergency Response Services (Medical Alert)
- Prostheses and Orthotics
- Rehabilitation Therapies
- Vision and Hearing Aids
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.
How to Apply / Learn More
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.
