Managed Long Term Care — New Horizon for Medicaid Home Care
The Medicaid Redesign Team was established by Governor Cuomo to work cooperatively and reform the Medicaid system in New York to improve health outcomes and control costs. The recommendations of the Redesign Team that were approved by the Legislature, as part of the enacted budget, are now being implemented. One of the most important initiatives is the transition of Medicaid home care consumers to care management or “Managed Long Term Care (MLTC) Medicaid.” Managed Long Term Care Plans (MLTCPs) must ensure that consumers transitioning from traditional Medicaid fee-for-service to MLTC have continuity of the care services they are currently receiving.
Mandatory enrollment began in the five boroughs of New York City late in 2012. We anticipate that Nassau and Suffolk Counties will start to implement the program this spring. Initially, persons who are age 65 or older, who need personal care services and are already receiving Medicaid benefits, can expect to receive correspondence from the Department of Social Services or the Human Resources Administration advising them of the need to enroll in a MLTC program. The notice suggests that the consumer select a MLTCP but indicates that, if the consumer fails to do so within a 60 day time period, one will be selected for them. The MLTCP selected will make an initial assessment of the consumer’s needs and will then establish a care plan. The plan should identify the amount, duration and scope of the services and should not arbitrarily reduce those services.
While we will continue to monitor and report on the new program, we strongly recommend that you contact our offices if you receive notice and would like assistance in the selection of a MLTC provider. Additionally, if you or a loved one has been assessed and the plan that is proposed does not meet your needs, or places inappropriate limits on service, it is important to note that new internal grievance procedures will apply and you must strictly adhere to the time constraints for seeking redress. Berwitz & DiTata LLP can assist you in this process.