New York State has approved senior ‘lock in’ to MLTC plans once the senior enrolls in the plan to receive care at home and/or at a social model day care program. The change goes into effect on December 1, 2018.
As of that date, during the first 90-day grace period after enrolling in an MLTC plan, the senior has the option to change MLTC plans for any reason. But after the 90-day grace period, the senior is locked-in and may not change plans for the next nine months.
However, if the senior can show a valid circumstance (called ‘good cause’) that requires them to be on a different plan, they may be permitted a change of MLTC plan during the lock-in period:
- the enrollee senior is moving from the plan’s service area,
- the plan fails to furnish the needed services, or
- it is determined that the MLTC enrollment was non-consensual (the senior was dropped by the plan).
Note that seniors enrolled in FIDA (a Medicare/Medicaid program under MLTC) and PACE (a managed care program for MLTC not widely available on Long Island) are not subject to these new limitations.
My law office provides legal representation and counsel on the legal and technical issues in the Medicaid MLTC program and nursing home care to protect your family. Please contact my office for a legal consultation.
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