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June 21, 2014

From the Office: What you need to know about Affordable Care Act, Medicaid redesign

There has been a wave shifting many individuals from traditional Medicaid into managed care companies as a result of New York’s program redesign. This change will affect some older adults enrolled in both Medicare and Medicaid, especially as it relates to long-term care in the home.

In 2011, Gov. Andrew Cuomo established a Medicaid Redesign Team, which developed and initiated a significant reform to the state Medicaid program, including a critical initiative to transition the state’s long-term care recipients into managed long-term care. The approval was granted by the Centers for Medicare and Medicaid Services to fully implement the transition and enrollment of individuals requiring community-based long-term care into Managed Long Term Care plans. 

This will expand MLTC for Medicaid members, age 21 or older, who are also eligible for Medicare (dual eligibles) and are receiving community-based long-term care services. The costs of skilled nursing facility services are included in the capitation payment, providing an incentive for the plans to keep their members healthy and living in the community.

There has been a planned rollout of this shift, starting with downstate and then moving to the larger city areas of upstate. In Schoharie County, letters will go out to individuals impacted with this change in July. The mandatory population includes the dual eligibles who are 21 or older, are expecting to need long-term care services for more than 120 days and are able to stay safely at home. There will be a small section of individuals who are not mandatory at this time: traumatic brain injury waiver participants, nursing home transition and diversion clients, care at home waiver participants and those dual eligibles who are older than 21 and do not require Community-Based Long Term Care services.

Consumers are encouraged to contact the enrollment broker, NY Medicaid Choice, to learn about their options. It provides counselors to assist and educate potential MLTC enrollees as to plan choices. There are three types of MLTC Plans:

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