Mandatory Medicaid Managed Long Term Care (MMLTC): An Overview of Changes Expected January 2014
Acknowledgements For helpful information and support to gather MMLTC info New York Legal Assistance Group Monroe County Legal Assistance Center Monroe County Department of Human Services Monroe County Office for the Aging New York Medicaid Choice Providers: Elderplan, Fidelis, ElderONE/PACE
Answers to Pertinent Questions What is Medicaid Managed Long Term Care? Why is it mandatory for some? Who is eligible? Who must/must not enroll? How do I choose a Plan? Which plans are available to me? Where to go if I have questions/problems?
Today s Acronym Key LTC Long Term Care MLTC Managed Long Term Care MMLTC Medicaid Managed Long Term Care PACE Program for All-Inclusive Care for the Elderly DHS Department of Human Services
Medicare v. Medicaid Medicare Medicaid Health insurance for persons 65 and older or disabled Eligibility NOT based upon income Hospital care, medical care, prescription medications Federal program Health insurance for low income persons of all ages who qualify Eligibility based upon income Can support care for chronic conditions/long term care Federal/State program
What is Medicaid Managed Long Term Care (MMLTC)? Medicaid + Managed (Care) + Long-Term Care The Public Health insurance program for the poor, operated by the State A type of private health insurance company paid a fixed amount per capita to authorize and pay for all covered services ( capitation ) Capitation Provider network Utilization Mgmt Non-primary care, non-acute care, non-emergency care (Medicareable) services which may include personal care, nursing care, therapies, adult day services Source: New York Legal Assistance Group, 2013
Why mandatory for some? Governor Cuomo creates NYS Medicaid Redesign Team, charged with saving billions $ from Medicaid Team recommends Mandatory MMLTC NYS authorized by Centers for Medicare and Medicaid to require MMLTC plans for those dually eligible (Medicare & Medicaid)
Timeline to Phase MMLTC into all of New York State Approved 2011 Started in NYC (Sept 2012) Expanded to Nassau, Suffolk & Westchester Orange, Albany, Erie, Onondaga & Monroe (Dec 2013) Other counties will follow dates TBD
Who must enroll in a MMLTC plan? You must join a plan if You have both Medicare & Medicaid (dually eligible), and You need home care, adult day health care, or other LTC for more than 120 days, and You are age 21 or older.
Who does NOT have to enroll Dual eligibles who do NOT require community-based long term care Nursing Home residents Nursing Home Transition and Diversion Medicaid Waiver participants Traumatic Brain Injury participants Assisted Living Program residents
Out with the old, in with the new Fee-for-Service Medicaid for Long Term Services and Supports (old) Bills paid directly by Medicaid/Medicare Providers bill and are paid for each service (more service, more money) Local Dept of Human Services Home and Community Based Service staff responsible for assessments Medicaid Managed Long Term Care (new) Bills paid by the Managed Care Plan Plan gets a lump sum for a package of services, or for treating one patient for a certain period. Plan responsible for assessments
How will I know I am eligible? You will receive a letter that will alert you that you must enroll in a MMLTC plan Sample Letter
How do I choose a plan? NY Medicaid Choice www.nymedicaidchoice.com 1-888-401-6582 Call Lifespan/Eldersource for other helpful guidance (585) 325-2800
Two types available in Monroe Co (at this time) Managed Long Term Care (MLTC) Medicaid Plan Plan covers Medicaid LTC services only (home care, personal care, adult day care, PERS, transportation, homedelivered meals (partially capitated) Must keep your Medicare plan for PCPs, Part D drug benefits, etc. Physicians/Services collaborate Program of All-Inclusive Care for the Elderly (PACE) Plan covers all Medicaid LTC services AND Medicare services (fully capitated) No need for a separate Medicare Plan Only for persons 55 yrs + in certain zipcodes (may change) Team of physicians/health care/service providers oversee all needs, members can receive care at the PACE center.
Commonalities in plans available All required to provide personalized care plans. Member reassessed every 6 months for any change in service, or when medical changes prompt a reassessment. Member may disenroll at any time must choose another plan, however. Members may have a Medicaid spend-down, payable directly to the plan. MLTC plans may disenroll a member for non-payment. Must enroll by the 20 th of the month for services to begin the 1 st of the following month.
Differences & Similarities Elderplan/Home First Fidelis/Care at Home United Healthcare Type of Plan MMLTC Medicaid Plan PACE ElderONE/PACE Minimum Age 18 yrs & older 55 yrs & older Full/Partial Cap Partial Full Who is eligible? All Monroe Co Selected zipcodes * May choose PCP Yes Sometimes Type of enrollment Voluntary or Involuntary Must be voluntary Medicaid Status Must be approved to enroll May be eligible to enroll * Have applied to serve all Monroe County residents, expect approval 2014
Mandatory enrollment If you do not join a plan, one will be chosen for you (auto enrollment). Choices for auto enroll may include any plan except PACE - this a voluntary enrollment plan ONLY.
Timeline for Mandatory MMLTC in Monroe County Mandatory MLTC process for Monroe County began December 2013 1. Announcement letter From NYS/DHS, 30 days prior to official letter to begin enrollment **Letters were sent at the beginning of December 2013 2. Letter to enroll From NY Medicaid Choice, will have 60 days to choose a plan **Those who must choose a plan will receive a letter in early January 2014
Advocacy Tips from Advocates WAIT until mandatory enrollment begins to choose a plan. Plans are required to provide a 90-day continuity of services (personal care, nursing, etc.), or until the plan conducts a new assessment, whichever is LATER, for transitions to new plans. If you want PACE, you must enroll this is not an auto enroll option. Plans contract to use specific nursing homes and adult day programs. Ask which are contracted with the plan you choose, if important to you. If you choose a MLTC Medicaid Plan you will still need a Medicare supplemental plan, part D, etc.
Helpful Resources Eldersource, for helpful guidance and any questions you may have: (585) 325-2800 or www.eldersource.org NY Medicaid Choice for assistance choosing a plan: (888) 401-6582 or www.nymedicaidchoice.com Medicaid Managed Long Term Care Guide http://www.health.ny.gov/health_care/medicaid/redesign/docs/mltc_gui de_e.pdf NYS Dept of Health s MLTC Complaint Hotline: (866) 712-7197 Elderplan: (866) 390-1562 Fidelis: (800) 688-7422 ElderONE/PACE: (585) 922-2831 United Healthcare: (877) 512-9354
Leanne Rorick, Director for Operations, Eldersource (585) 325-2800 lrorick@lifespan-roch.org