NYC Human Resources Administration Issues Medicaid Alert

The New York City Human Resources Administration issued a Medicaid Alert about mandatory enrollment into Managed Long Term Care Plans.

UPDATE - Mandatory Enrollment into Managed Long Term Care Plans

The New York State Department of Health announced that it has received written approval from the federal government to require dual eligible (Medicare/Medicaid) consumers who are age 21 and older and in need to community-based long term care services for more than 120 days, to enroll in a Managed Long Term Care pln.  As a result, effective September 17, these consumers will no longer be able to make an initial application for stand alone fee for service personal care services through HRA’s Home Care program.  At this time, dual eligible consumers can continue to apply for the Long Term Home Health Care program and the Consumer Directed Personal Care program as well as Managed Long Term Care.

Effective Monday, September 17, 2012,  HRA’s Home Care program will no longer accept new M11Qs for personal care from dual eligible consumers who are age 21 and older.   If HRA’s Home Care Program has already received a completed M11Q as of September 14, 2012  for a consumer within this population who is newly requesting personal care services, the client will be assessed for personal care services and, if found eligible, services will be put in place—until the client is selected for mandatory enrollment into a MLTC.    HRA’s Home Care program will, of course, continue to accept and process Medicaid applications for consumers in need of community based long term care.   Clients requiring assistance in completing the Medicaid application can call the HRA Infoline at 718-557-1399 to request a Homebound Medicaid visit.

Dual eligible consumers, aged 21 and over, in need of community based long term care services who know they want to enroll in a Managed Long Term Care plan can call New York Medicaid Choice for assistance in choosing a plan. New York Medicaid Choice has established a new phone number for the MLTC initiative:  888-401-MLTC (6582).  If a consumer has already selected a managed long term care plan, they can either contact the plan directly or contact New York Medicaid Choice who will help connect them to the plan.

New York State Department of Health has filed an amendment to its 1915c waiver to require Long Term Home Health Care (Lombardi) clients to enroll into Managed Long Term Care.   Until that waiver is approved, consumers will continue to be able to enroll into or retain enrollment in Long Term Home Health Care programs.   The Consumer Directed (CD-PAP) program will be included in managed care --- both mainstream and managed long term care--- at some point in the future.   Until that program is transitioned, clients should continue to apply for the CD-PAP program through HRA’s Home Care program.   If clients are applying for CD-PAP services, they should clearly indicate so with their M11Q submission.   Consumers who would like assistance with their choice between Managed Long Term Care, Long Term Home Health Care, and Consumer Directed Personal Care should call their local CASA office.

Consumers currently in receipt of hospice care are excluded from Managed Long Term Care enrollment.  Such consumers remain eligible for fee-for-service personal care services.

For additional information regarding the transition of dual eligible consumers currently in receipt of personal care services, please refer to the July 3rd Medicaid Alert, Mandatory Enrollment into Managed Long Term Care.  Please be reminded that clients in waiver programs (e.g. Traumatic Brain Injury, Nursing Home Transition and Diversion Clients, Home and Community Based Services, etc) may inadvertently receive mandatory enrollment packages.   These clients are currently exempt from mandatory enrollment.  If you become aware of such a client receiving a mandatory package, please let them know they can contact NY Medicaid Choice and ask for an exemption from enrollment based on their participation in one of these waiver programs.

HRA’s Home Care program will continue to accept M11Qs for personal care services for consumers exempt from mandatory MLTC enrollment.

Reproduced with permission from the NYC Human Resources Administration, the Medical Insurance and Community Services Administration (MICSA)

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