Program Description
This Medicaid program is intended to help eligible seniors with chronic illnesses or disabilities who 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.
New York’s Managed Long Term Care consists of three plans. Participants can select from the following plans:
- Managed Long Term Care (MLTC) Medicaid Plan — 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.
- Program for All-Inclusive Care for the Elderly (PACE) — The PACE plan allows individuals who are 55 or older to receive their care through a medical team.
- Medicaid Advantage Plus (MAP) — 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
General Requirements
Age
Applicants must be at least 18 years of age to enroll in the MLTC program.
PACE Plan participants must be 55+.
New York residents who are (1) 21 years of age or older, (2) are dual eligible (qualify for both Medicare and Medicaid), and (3) have a need for long-term care for more than 4 months are required to enroll in a NY Managed Long Term Care Plan.
Functional Ability
All 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 Requirements
On the financial side, a senior applicant’s income and assets must fall within New York’s Medicaid limits.
Income Limits
As of 2023, an individual applicant can have monthly income no greater than $1,677. A married couple with both spouses as applicants is allowed $2,268 a month in income.
When only one spouse requires MLTC services, the applicant spouse may be able to transfer up to $3,715.50 a month income to the non-applicant spouse in order to prevent spousal impoverishment.
Asset Limits
An individual’s resources must be less than $30,182. Couples with both spouses applying are allowed up to $40,821 in assets. When only one spouse is applying, the non-applicant spouse may be able to retain up to $148,620 of the couple’s joint assets as a community spouse resource allowance, which is an addition to the $30,182 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 an applicant’s financial resources unless neither the applicant nor his/her spouse intends to live in it. Also, applicant’s should be aware that there is a limit of $1,033,000 on the equity value of their home.
Over the Financial Limits?
New Yorkers whose income or assets surpass Medicaid’s limits may still be able to receive some Medicaid benefits by working with a Medicaid planning expert. These professionals can assist 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 savings 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
One can apply through any Local Department of Social Services. Those who have questions or need assistance can call New York Medicaid Choice at 1-888-401-6582.
More information on the program can be found via the state’s consumer guide to MLTC, available here.
