New York's dual-eligible (Medicare and Medicaid) long-term-care delivery system is Managed Long Term Care (MLTC), which has two lines of business relevant to seniors: standard MLTC/Medicaid Advantage Plus plans, and PACE (Program of All-Inclusive Care for the Elderly) for members age 55 and older.
What MLTC coordinates
MLTC plans coordinate long-term services and supports -- home care, adult day care, nursing home care and ancillary/ambulatory services -- for enrollees who need nursing-home-level care but can remain in the community. PACE additionally combines Medicare and Medicaid financing under one plan for members 55 and older.
Is it mandatory here?
Yes. Mandatory MLTC enrollment has applied in Nassau and Suffolk counties since the transition period that began in 2013, for Medicaid recipients aged 21+ who need community-based long-term care for more than 120 days.
MLTC also carries a Long Island-specific detail worth knowing: the “special income standard for housing expenses” available to certain MLTC enrollees is $1,701 for the Long Island region, a different figure than in NYC or upstate regions.
