Are you, your loved one, or someone you know enrolled in a Managed Long-Term Care (MLTC) Plan? If you live in New York State, receive more than 120 days of long-term care per year, and have Medicare and Medicaid you most likely are a member of an MLTC plan. For more information on MLTC plans, you can see our MLTC flier.
If you are not enrolled in an MLTC plan and need long-term care services, please read our blog about enrolling in long-term care plans. Before you can enroll in an MLTC plan, you need to be assessed by a nurse. Our blog explains the process of getting an assessment and other steps for enrolling in an MLTC plan.
Every person enrolled in an MLTC plan should have a personalized care plan that lists the specific services the plan will provide. According to the model contract MLTC plans sign with the state of New York, each individual care plan should be developed in collaboration with the person enrolling in the plan, that person’s family, the care manager from the MLTC plan, the licensed medical professionals provided by the plan, and other appropriate community resource or service providers.
Your care plan will include your health care goals, the types of services your MLTC plan will cover and how often you receive those services, and instructions on how to monitor and evaluate services by the plan so that you and your loved ones can make sure that the care plan is meeting your health needs. Your MLTC plan should provide a sufficient and adequate delivery of all services in the care plan. In order to do this, your MLTC plan needs to maintain a network of providers that can give you the services you need. Also, in order to keep your care plan up to date, you will be assessed by a nurse every six months (or sooner if there has been a significant change in your health condition). This is to make sure that your care plan continues to meet your needs.
If you ever want to discuss or review your care plan, or make any changes, you should contact your care manager at your MLTC plan. Each MLTC enrollee should be assigned his or her own personal care manager. Your care manager should be familiar with you and your care plan and is the person to contact if you have any questions about your MLTC services. According to the model contract your MLTC plan signed with the State of New York, your care manager is supposed to help you get the services that are part of your care plan. He or she should have access to your providers and should help you if you have any problems getting the care you need.
Remember that when you are enrolled in an MLTC plan, there are many ways to make sure that you have the best experience possible. One way is to be involved in the creation of your care plan. You are allowed to ask for a copy of your care plan, and you are allowed to work with your care manager to make changes. Keep in touch with your care manager on a regular basis and be sure that they are up to date about your needs and whether or not your needs are being met.
The Medicare Rights Center’s Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE) tracks changes New Yorkers with Medicare and Medicaid and long-term care experience, and we would like to hear your story. CPRNYDE works with consumers directly and ensures their voices are heard by policymakers. We are currently working with a group of consumers and caregivers, and we are reviewing the way care plans work and do not work. We aim to improve enrollee’s experiences with their care plans and care managers. If you would like to partake in this work, please let us know!
If your MLTC plan doesn’t seem to be in compliance with New York State requirements or the model contract, you can also contact the Independent Consumer Advocacy Network (ICAN), at (844) 614-8800. ICAN is the New York State Ombuds program for Managed Long-Term Care and provides free and confidential assistance. They have counselors who are ready to assist you with any concerns.