Managed Long Term Care Plans
Mandatory Enrollment
Linda Gowdy
Home Care Association
May 31, 2012
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Managed Long Term Care Models
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Three MLTC models:
1. Partially Capitated Managed LTC (Medicaid)
Benefit package is long term care and ancillary services
including home care, unlimited nursing home care
2. Program of All-Inclusive Care for the Elderly
(PACE) (Medicare and Medicaid)
Benefit package includes all medically necessary services –
primary, acute and long term care
3. Medicaid Advantage Plus (MAP) (Medicare and
Medicaid)
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Benefit package includes primary, acute and long term care
services (excludes some specialized mental health services)
Mandatory Enrollment in MLTC
and Care Coordination Models
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2011 Budget legislation requires:
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All dual eligibles who are 
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Age 21 and older and In need of community-based long term care services for
more than 120 days
Must enroll in a Managed Long Term Care
Plan or other Care Coordination Model
Duals between 18 and 21 remain voluntary
Mandatory Initiative
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1115 Waiver approval needed from CMS before we
can start (July, 2012 target)
Eliminates the need to score as Nursing Home
eligible upon enrollment
Definition of community-based long term care
services includes:
– Personal care services
– Home health services
– Adult day health care
– Private duty nursing
Initiate Mandatory Enrollment in
New York City

DOH worked extensively with HRA and Enrollment Broker
(Maximus) to develop process for effectively transitioning
people.
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Will not take place all at once
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By program
By borough
Consumer Choice preferred but Auto Assignment for those who
do not choose
Must ensure continuity of care plan and service provider
Significant educational component for people new to system
and transitioning
Enrollment of those receiving Consumer Directed Personal
Assistance services will not begin until September, 2012
Statewide Mandatory Enrollment
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There must be a choice of plans in urban
areas, at least one in rural counties
Upstate expansion will be county by county,
as sufficient MLTC plan capacity is
developed
Roll-Out of Mandatory
Managed Long Term Care
•
Mandatory Population: Dual eligible, aged 21 and over,
receiving community based long term care services for over
120 days, excluding the following:
• Nursing Home Transition and Diversion waiver
participants
• Traumatic Brain Injury waiver participants
• Assisted Living Program participants
• OPWDD waiver recipients
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Voluntary Population
In addition to those who must enroll in a Managed
Long Term Care Plan, the following people may
voluntarily enroll:
•
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Dual eligible, 18-21, in need of community based long
term care services for over 120 days.
•
Non-Dual eligible, age 18 and older assessed as nursing
home eligible.
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Phase I: New York City
People New to Service
Beginning July, 2012 - Any dual eligible case new to service,
fitting the mandatory definition in any New York City county
will be identified for enrollment and referred to the Enrollment
Broker for action.
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Enrollment Broker will provide with educational material, list of
plans/CCMs, answer questions and provide assistance contacting a
plan if requested.
Plan/CCM will conduct assessment to determine if eligible for
community based long term care.
Plan/CCM transmits enrollment to Enrollment Broker
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Transition of Personal Care
Recipients
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People in service will be noticed in batches
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To avoid disruption, people noticed for
transition will have:
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Initial batch will be about 2,000 people
Batch may increase as we gain experience and
success
At least 120 days left on personal care
authorization
At least 120 days left on Medicaid eligibility
Enrollment Broker Activities

Those in service will receive:
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Announcement Letter (telling them mandatory is
coming)
Letter telling person he/she has 60 days to
choose a plan. Mailing will include:
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Brochure describing MLTC
List of Plans (Partial, PACE and MAP)
Phone number for Enrollment Broker for assistance
Significant follow-up by phone and mail
encouraging individual to choose a plan
Enrollment Broker Activities (cont.)
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Enrollment Broker will have plan networks to
assist individual to receive services from
current/preferred providers
At 45th day, if no choice is made individual will
receive letter telling to which plan will be autoassigned if no choice made by day 60.
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Auto-assignment will only be to Partially capitated
plans (others would require Medicare enrollment)
Enrollment will begin on 1st of the month
If dissatisfied, individual can transfer to another
plan (no lock-in)
Continuity of Care
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MLTC Plans:
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Must have contracts with NYC Home Attendant Vendors to
assure that new enrollees will be able to continue with their
workers
Must pay the vendor at the HRA rate.
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Not required to contract with a vendor that will not accept the HRA rate
Must submit a plan for providing continuity of services other
than personal care
Are encouraged to augment network providers
Service Plan Will Continue/
Assessment Required
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MLTC Plan will continue existing authorized service
plan
Plan required to conduct assessment within 30 days
of enrollment
If propose to reduce hours before authorization
ends, must issue a Notice of Action
– Enrollee has right to appeal rights with aid
continuing
– Fair hearing rights if appeal is adverse to enrollee
People in Service
•
Enrollment will be phased-in by service type by borough by zip
code in batches. People will be given 60 days to choose a plan
according to the following schedule:
• July 1, 2012: Begin personal care* cases in New York County.
• August 1, 2012: Continue personal care cases in New York
County.
• September, 2012: Continue personal care cases in New York
County and begin personal care in Bronx County; and begin
consumer directed personal assistance program cases in New
York and Bronx counties.
• October, 2012: Continue personal care and consumer directed
personal assistance program cases in New York and Bronx
counties and begin Kings County.
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Phase 1
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(continued)
November 2012: Continue personal care and consumer
directed personal assistance program cases in New York,
Bronx and Kings counties
December 2012: Continue personal care and consumer
directed personal assistance program cases in New York,
Bronx and Kings Counties and begin Queens and
Richmond counties
January 2013: Initiate enrollments citywide of long term
home health care program, home health over 120 days,
adult day health care program and private duty nursing
cases not enrolled under personal care case activity.
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Phase 1(Cont.)
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February 2013 and until all people in service are
enrolled: Personal care, consumer directed personal
assistance program, long term home health care program,
home health over 120 days, adult day health care program
and private duty nursing cases in New York, Bronx, Kings,
Queens and Richmond Counties
• *Individuals receiving personal care while enrolled in
Medicaid Advantage will begin MLTC/CCM enrollment in
January, 2013.
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Next Phase(s)
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As plan capacity is established, dually eligible community
based long term care service recipients will be enrolled as
follows:
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Phase II: Nassau, Suffolk and Westchester Counties –
Anticipated January 2013.
Phase III: Rockland and Orange Counties – Anticipated June
2013.
Phase IV: Albany, Erie, Onondaga and Monroe Counties –
Anticipated December 2013.
Phase V: Other counties with capacity – Anticipated June 2014.
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Final Phase
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Phase VI: Previously excluded dual eligible groups
contingent upon development of appropriate programs:
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Nursing Home Transition and Diversion waiver
participants
Traumatic Brain Injury waiver participants
Assisted Living Program participants
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