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Mandatory Enrollment of Nursing Home residents into Managed Care & MLTC - scheduled to begin Feb. 1, 2015

27 Jan, 2015

Nursing Home Resident Transition to Managed Care

February 1, 2015 marks the start date for the  new requirement for nursing home residents who became "permanent" residents after that date to enroll in managed care or MLTC plans.   CMS approved this expansion of MLTC and mainstream Medicaid managed care by letter of Dec. 31, 2014.

On Jan. 22, 2015, NYS DOH conducted a webinar on this transition: 

and soon thereafter issued revised policies and procedures and an FAQ:

NOTE that DOH has always said that no one who is a current nursing home resident will be required to move out of their nursing home.   If they are required to enroll in an MLTC plan or, if they are not on Medicare, in a "mainstream" managed care plan, they will enroll in a plan that affiliates and pays for their current nursing home.

Here is the e-mail from the Medicaid Redesign Team sent on Dec. 29, 2014:

"The Phase-In Schedule for the transition of the Nursing Home Benefit and Population into Medicaid Managed Care and Managed Long Term care has been revised as follows:

Phase 1- February 1, 2015

New York City – Bronx, Kings, New York, Queens, and Richmond counties

Phase 2- April 1, 2015

Nassau, Suffolk and Westchester counties

Phase 3- July 1, 2015

Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Montgomery, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Otsego, Putnam, Rensselaer, Rockland, St. Lawrence, Saratoga, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Sullivan, Tioga, Tompkins, Ulster, Warren, Wayne, Washington, Wyoming,  and Yates counties

October 1, 2015

All counties - voluntary enrollment in Managed Long Term Care, Fully Integrated Duals Advantage and Mainstream Medicaid Managed Care becomes available to individuals residing in nursing homes who are in fee-for-service Medicaid

As the three-way contract for FIDA indicates, voluntary and passive enrollment for eligible individuals in nursing homes will take place on or after August 1, 2015. More information will be forthcoming on the exact timeline.

Thank you,

The Medicaid Redesign Team

*********************************************************************************************************************************

  The website is  DOH MRT 1458  - scroll down to this heading:

February 1, 2015 (*) Population Transition – Nursing Home ("New" Duals and Non-Duals) (FIDA Region Adults) (NYC, Nassau, Suffolk & Westchester)
(*) Transition date has changed

Presumably CMS is ready to approve this expansion because the State has met two conditions on approval of this expansion.  First, the Conflict Free Eligibility & Enrollment Center has been  launched -- this  expands the role of Maximus/NY Medicaid Choice to include assessing all applicants for MLTC and determining their eligibility, before they can enroll in an MLTC plan.   Now, NY Medicaid Choice is the "enrollment broker," responsible for counseling people on their options for MLTC plans and enrolling them, and, in mandatory counties, sending the notices giving current home care recipients 60 days to select a plan or be auto-enrolled.   The second condition on this expansion is establishing the Ombudsprogram, which has been launched as the ICAN program, administered by the Community Services Society.

See more information on this expansion of managed care and MLTC in this article. 


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