Managed Long Term Care, or MLTC, is a plan that arranges long term services for homebound chronically ill or disabled people, and is covered by the New York Medicaid Program.
1) The New York State Department of Health reviews, approves, and lists all MLTC insurance plans in New York.
2) There are three types of MLTC programs in New York: PACE, MLTC Partial Capitation Plans, and Medicaid Advantage Plus.
3) PACE, or Program of All-Inclusive Care for the Elderly, covers all Medicare and Medicaid programs, and requires members to be over 55 and eligible for nursing home admission.
4) FIDA (Fully Integrated Duals Advantage) participants get all their covered Medicare and Medicaid services from one plan, including long term services and supports (LTSS) and prescription drugs.
5) MLTC Partial Capitated plans only cover Medicaid long term care services, not primary medical care services.
6) Medicare Advantage Plans are NOT the same as Medicare Advantage Plus. Medicare Advantage Plans do provide primary medical care paid for by Medicare and/or Medicaid.
7) Medicare Advantage Plus provides both Medicare and Medicaid primary medical care and long term medical care.
8) MLTC does NOT affect other Medicaid and Medicare services. Any services, coverage, and benefits covered by Medicaid and Medicare will not be lost if you receive MLTC.
9) Eligibility for MLTC includes people who meet the age requirement, are either dual or non-dual eligible, and requires community or home-based long term care services for over 120 days. Dual eligibility is when an individual is eligible for both Medicare and Medicaid coverage.
10) CDPAS (Consumer Directed Personal Assistance Services) is a statewide Medicaid program that allows patients who are eligible to receive home care from a family member who can actually be paid for their services.
Source: NYS Department of Health
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