Managed Long Term Care Program spacer
1) What is managed Long Term care?

Managed Long Term care (MLTC) is a program that was designed to assist members with chronic illnesses and those who require community-based long term care services.

2) Do I have to enroll in a MLTC plan?

No, you are not mandated to join a plan unless you receive a letter from Medicaid stating that you must join.

3) Who is eligible to enroll in a Managed Long Term Plan?
  • Medicaid eligible as determined by HRA/LDSS
  • Are 21 years or older
  • Live in New York City (the boroughs of the Bronx, Brooklyn, Manhattan, Queens, and Staten Island) or Nassau and Suffolk counties.
  • Have a chronic condition or serious disability that makes you eligible for Nursing Home Level of care, if applicable
  • Are expected to need long term care for more than120 days
  • Are at the time of enrollment able to remain in your home safely without jeopardizing your health.
4) How does your plan assist me?

Each member will be assigned their own Care Manager. Your Care manager is a Registered Nurse who is trained in managing chronic conditions.

Our Care manager will work with you, your Doctor’s, and your caregiver to ensure you receive a personalized Plan of care to meet your needs.

5) What is the purpose of the Care manager program?
  • Increase disease prevention and reduce disease progression
  • Promote early detection of serious medical problems
  • Promote Member outreach and education to assist Members in achieving independence
  • Establish a collaborative relationship between your Care Manager and your Physician through information sharing (where applicable)
6) Do I need Medicare?

No, you do not have to have Medicare to be eligible. The MLTC program is for nondual eligible’s (Medicaid only) as well as dual eligible’s ( Medicaid and Medicare).

7) What does the MLTC not cover (including, but not limited to)?
  • Hospitalizations
  • Physicians (PCP and Specialists)
  • Lab tests
  • Pharmacy benefits
  • Behavioral Health
8) Can I keep my Primary care Doctor?

Yes, this is usually covered by Medicare. If you are currently receiving Medicaid only you will still receive the same type of services. You will not lose any of your regular benefits. If the service is not covered by the plan, you may still receive the services by using your Medicare or Medicaid card.

9) How do I enroll in managed Long Term care?

To begin the process of enrollment you or a designated person on your behalf must contact the Conflict-Free Enrollment and Evaluation Center (CFEEC) at 1-855-222-8350 to schedule an initial eligibility assessment. Following the CFEEC assessment, if you are deemed eligible, you or a designated person on your behalf can contact the plan at 1-855-299-6492. An Enrollment Specialist RN will be scheduled to visit you in your home before you join to provide you with the following

  • Rules and responsibilities of the plan membership
  • Complete an assessment to determine eligibility
  • Assist you with completing the enrollment application
  • Provide you with a copy of the Member Handbook and Provider Network
  • Provide you with a Plan of Care to address your needs
  • Answer any questions you may have
  • Assist you in selecting providers associated with the plan
10) Will communication barriers be an issue?

No. We have a robust bi-lingual staff to address your needs and provide translation services. We provide materials in several languages, including brail and audio discs to accommodate your needs. Our Provider Directory lists all providers who speak languages other then English. Individuals who are hearing, visual, or speech impaired can also utilize the TTY New York Relay Service to communicate with plan representatives. We also have a language line service with highly qualified and experienced interpreters to facilitate communication.

11) What if I have additional questions?

Call our Member service Department at 855-299-6492. Our member service reps are bi-lingual and are available to answer any additional questions you may have. Our reps will also send you our brochure upon your request which will include detailed information about our plan.