What Is Managed Long-Term Care (MLTC)?
If you or someone you care for needs ongoing help with everyday activities, you may be wondering how to get the right care and support while continuing to live at home. Managed Long-Term Care, often called MLTC, is a New York State Medicaid program that helps eligible people receive long-term services and supports in their home and community.
Understanding Long-Term Care
Long-term care refers to services and support you may need over an extended period because of a chronic illness, disability or difficulty performing everyday activities.
Unlike care you may receive for a short-term illness or injury, long-term care focuses on helping you maintain your health, safety and independence over time.
Depending on your needs and eligibility, long-term care services may include help with activities such as bathing, dressing and other personal care needs, as well as nursing, therapies and other services provided in your home or community.
How Does Managed Long-Term Care Work?
With MLTC, your long-term care services are coordinated through a health plan approved by the New York State Department of Health.
Your MLTC plan works with you to understand your needs and develop a person-centered plan of care. The plan also helps coordinate the long-term care services you are authorized to receive so that the different people involved in your care can work together.
The goal is to help you receive the support you need to live safely and as independently as possible in your home and community.
What Services Can an MLTC Plan Provide?
The specific services you receive are based on your individual needs, eligibility and plan of care. Depending on your needs, covered long-term services and supports may include:
- Personal care services, such as assistance with bathing, dressing and other activities of daily living
- Nursing services in your home
- Home health aide services
- Physical, occupational or speech therapy in your home
- Adult day health care
- Consumer Directed Personal Assistance Services (CDPAS)
- Private duty nursing
- Other covered long-term care and supportive services
Your care needs are assessed to determine which services are appropriate for you and how those services will be provided.
Who May Qualify for MLTC?
MLTC is intended for people with ongoing long-term care needs who meet New York State's program requirements.
Eligibility depends on several factors, including your Medicaid eligibility, the type and level of assistance you need, how long you are expected to need long-term care services and the specific type of MLTC plan you are considering.
New York State uses an assessment process to evaluate an individual's needs. For certain MLTC plans, individuals seeking enrollment must be assessed as needing community-based long-term services and supports for more than 120 days and must meet the state's minimum-needs requirements.
Because eligibility is based on your individual circumstances, an assessment is an important part of determining whether MLTC is right for you.
What Is the Difference Between MLTC, Medicaid and Medicare?
It can be confusing because these programs can work together, but they are not the same.
Medicaid is a government health Coverage program that helps eligible people with health care and long-term care costs. MLTC is one way New York Medicaid organizes and provides long-term services and supports for eligible individuals.
Medicare generally covers medical services such as doctor visits, hospital care and certain other health care services. It does not generally cover ongoing custodial long-term care.
If you have both Medicare and Medicaid and enroll in an MLTC Partial Capitation plan, you generally continue to use your Medicare Coverage for Medicare-covered services. In contrast, your MLTC plan coordinates your Medicaid-covered long-term care services.
Other types of managed long-term care programs may combine more of your Medicare, Medicaid and long-term care benefits into one plan.
Are There Different Types of Managed Long-Term Care?
Yes. New York's Managed Long-Term Care program includes different plan types.
MLTC Partial Capitation plans primarily coordinate Medicaid-covered long-term care and certain other services. Medicare-covered medical care generally remains separate.
Medicaid Advantage Plus (MAP) plans combine Medicare and Medicaid Coverage with long-term care services through an integrated plan for people who meet the program's requirements.
Programs of All-Inclusive Care for the Elderly (PACE) provide an integrated system of Medicare, Medicaid and long-term care services for eligible individuals age 55 and older.
Each program has its own eligibility and enrollment requirements.
How Do I Know if MLTC Is Right for Me?
You may want to learn more about MLTC if you have Medicaid and need ongoing assistance to remain safely at home because of a chronic illness, disability or difficulty with everyday activities.
Choosing a plan is an important decision. Before enrolling, consider the services you need, whether the plan serves your area, which providers participate in its network and how the plan will coordinate your care.
You should also understand what services the MLTC plan covers and what services will continue to be covered separately through Medicare, Medicaid or other Coverage you may have.
Getting Started
If you think you or someone you care for may need long-term care, the first step is understanding your needs and eligibility.
An assessment may be required to determine whether you qualify for Managed Long-Term Care and the type of services and assistance you may need. Once eligibility is determined, you can review the MLTC plans available in your area and choose the option that best meets your needs.
Remember, Managed Long-Term Care is designed to coordinate ongoing care and support so eligible New Yorkers can continue living safely and independently in their homes and communities for as long as possible.