Fees & Insurance

Fees & Insurance

Managed long-term care (MLTC) is a system that streamlines the delivery of long-term services to people who are chronically ill or disabled and wish to stay in their homes and community. Each plan has its own network of providers, including services such as home care agencies, adult day care and other professionals. MLTC providers are approved by the New York State Department of Health.

As New York transforms its long-term care system to one that ensures care management for all, enrollment in a MLTC plan may be mandatory or voluntary.

Enrollment is mandatory if:

  • You have both Medicaid and Medicare
  • You need home care, adult day health care, or other long term care for more than 120 days (four months)
  • You are age 21 or older

Enrollment is voluntary if:

  • You have both Medicaid and Medicare, are 18-21 years of age and need community based long term care for more than 120 days (four months) and assessed as nursing home eligible
  • Are non-dual eligible and over 18 years of age and are assessed as nursing home eligible

You must join a Plan if you received a letter from New York Medicaid Choice telling you to join a Plan by a certain date. As an enrolled member, you will have a Care Manager to help find the right Plan that caters to your needs and possibly approves any current services. There are three different types of Plans:

MLTC Medicaid Plan
Medicaid Advantage Plus
Program for All-Inclusive Care for the Elderly (PACE)

Here are some of the services provided by a MLTC Medicaid Plan:

  • Heath Services At Your Home
  • Nurses
  • Home Health Aides
  • Physical Therapists
  • Personal Care
  • Help with bathing, dressing, and grocery shopping
  • Adult Day Health Care
  • Social Day Care
  • Nursing Home Care
  • Specialty Health
  • Audiology, Dental, Optometry, Podiatry, Physical Therapy
  • Other Services
  • Home-delivered meals, personal emergency response, transportation to medical appointments

With a Medicaid Advantage Plus Plan, one granted the services above, along with other Medicare services, such as:

  • Doctor office visits
  • Specialty care
  • Clinic visits, hospital stays
  • Mental health services
  • X-ray and other Radiology services
  • Chiropractic care
  • Medicare Part D drug benefits
  • Ambulance services

The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits. Financing for the program is capped, which allows providers to deliver all services participants need rather than limit them to those reimbursable under Medicare and Medicaid fee-for-service plans. Individuals can join PACE if they:

  • Are age 55 or older
  • Live in the service area of a PACE organization
  • Are eligible for nursing home care
  • Are able to live safely in the community

To learn more, click the button below:

Long Island Alzheimer's and Dementia Center currently has MLTC contracts with Aetna and Agewell (see contact information below). If you have a different MLTC plan, please call your provider to apply for a single-case agreement to cover your loved one’s program expenses.

Aetna
www.aetna.com

Agewell
Toll Free: 1-866-586-8044
TTY/TDD: 1-800-662-1220
info@agewellnewyork.com
www.agewellnewyork.com