NYMC Insert: MLTCP benefit change information for new enrollees (also mailed to all MLTCP enrollees in 2020)

  • Insert is also available in Portable Document Format (PDF)

Important Notice: How Long-Term Nursing Home Care is Covered Under MLTC Medicaid Plans

This notice is to tell you how long-term nursing home benefits are covered for MLTC Medicaid plan members. For more information, contact any one of the organizations listed in this notice.

What is a long-term nursing home stay?

A long-term nursing home stay decision is made between you, your doctor, and your nursing home. It means that based on an assessment of your medical needs, you are not expected to return home or to another community setting. A long-term nursing home stay decision does not prevent you from changing your mind and returning to the community if it is safe for you to do so.

How will my long-term nursing home care be covered?

MLTC Medicaid Plans only cover three months of long-term nursing home care. If you are in a long-term nursing home stay for more than three months, you will get a letter from New York Medicaid Choice telling you when you will be disenrolled from your plan. New York Medicaid Choice will help you and give you information about other Managed Long Term Care (MLTC) plan options.
Note: MLTC Medicaid Plans cover temporary stays in a nursing home.

Does my Medicaid eligibility change if I am disenrolled from my plan?

No. Your Medicaid eligibility is not based on whether you are in an MLTC Medicaid Plan. It is based on the type of services you need coverage for: community-based or long-term care services.

What if I have more questions?
  • Your MLTC Medicaid plan can answer your questions. You can find the plan’s phone number in the letter you received with this notice.
  • The Independent Consumer Advocacy Network (ICAN) is the ombudsman program for health plan members. ICAN can give you free, independent advice about your coverage, complaints, and appeal options. To learn more, go to www.icannys.org, or call 1-844-614-8800 between the hours of 8am to 6pm. TTY: 711. All services are free.
  • You can also call New York Medicaid Choice at 1-888-401-6582 (TTY: 1-888-329-1541) Monday through Friday, from 8:30 am to 8:00 pm and Saturday, from 10:00 am to 6:00 pm.