What is a Managed Long Term Care Plan?

We hear about MLTCs and Managed Long Term Care a lot, but exactly are they, and what do they do?

An MLTC is a company that manages health care services and other services for a NYS senior or person with disabilities on Medicaid who is 21+ and needs long term care for more than four months. Enrolment in an MLTC is required if a person is approved for Medicaid long term care through the evaluation by Maximus (the Conflict Free Evaluation and Enrolment Center). This is a lengthy appointment with a nurse who goes over all activities of daily living and medical conditions.

Which MLTC an individual joins is up to them. Some MLTCs in downstate NY are Centersplan, Healthfirst, Fidelis, VillageCareMAX and Integra. At each MLTC, there is a care manager to communicate with about a personalized plan of care and services. These services may include transportation to medical appointments, meals delivered to the home, as well as home care and other types of long term care.

Many people choose their MLTC based on the home care services offered. You may choose the agency you want to work with to supply the aides, such as Caring Professionals. However, social adult day care, adult day health care and nursing home care are also available. Nursing home care through an MLTC has additional requirements and a 60-month financial look back period.

There are other options out there…..

Many people choose a dual plan that manages both Medicare and Medicaid together. This is called Medicaid Advantage Plus.

Another long term care option is a PACE program. PACE stands for Program for All-Inclusive Care for the Elderly and it is just that. The senior spends the day at the plan’s adult day center and gets medical care there. There are other benefits such as personal care, home delivered meals, and more.

An MLTC is responsible to keep the individual healthy and gets paid by Medicaid to do so. It is worthwhile to maintain regular communication with the care manager.

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