Managed Long Term Care (MLTC)

Generated from the gc-benefits catalog. It lists what the owner record states. It is not an eligibility decision; confirm current rules with the program.

Community based long term services and supports (CBLTSS) such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health. CBLTSS includes nursing services in the home, therapies in the home, home health aide services, personal care services in the home, adult day health care, private duty nursing, or Consumer Directed Personal Assistance Services (CDPAS).

• Owner record: ny/managed-long-term-care-program
• Jurisdiction code: NY
• Frame: care_recipient
• Review by: 2026-11-13
• Authority: New York State Department of Health

Offering 1: MLTC Partial Capitation (MLTCP)

This line of business provides community based long term care and ancillary services, including home care and up to 3 months of nursing home care.

• Availability (owner codes): {"intake": "unknown", "type": "unknown"}

Conditions:

• All of these:
• Fact rule: recipient.age ≥ 18
• Fact rule: recipient.medicaid_eligible is true
• Stated condition, not checked automatically: "individuals must be assessed as needing community based long term services and supports (CBLTSS) for more than 120 days"
• Stated condition, not checked automatically: "at least limited assistance with physical maneuvering with more than two activities of daily living (ADLs); or individuals with a Dementia or Alzheimer's diagnosis, assessed as needing at least supervision with more than one ADL."
• Any one of these:
  • Stated condition, not checked automatically: "Are dual eligible (Medicaid and Medicare), age 21 and older, receiving CBLTSS for more than 120 days and meets the Minimum Needs Requirements. Reside in New York State."
  • Stated condition, not checked automatically: "Dual eligible individuals, aged 18 through 20, who must be assessed as needing CBLTSS for more than 120 days and meet the Minimum Needs Requirements."
  • Stated condition, not checked automatically: "Non-dual eligible individuals, age 18 and older, who must be assessed as needing CBLTSS for more than 120 days and meet the Minimum Needs Requirements."

Access route 1.1

• Where: Request an enrollment assessment with the New York Independent Assessor Program (NYIAP)
• How: Schedule an assessment with NYIAP.
• Phone: 1-855-222-8350

Offering 2: Medicaid Advantage Plus (MAP)

The MAP plan works together with a Medicare plan to administer all of your Medicare, Medicaid, long term care, and drug benefits under one health care organization.

• Availability (owner codes): {"intake": "unknown", "type": "unknown"}

Conditions:

• All of these:
• Fact rule: recipient.age ≥ 18
• Fact rule: recipient.medicaid_eligible is true
• Stated condition, not checked automatically: "Reside in the Plan's service area"
• Stated condition, not checked automatically: "Have evidence of Medicare Part A & B coverage"
• Stated condition, not checked automatically: "Enroll in the MAP plan’s aligned Medicare Advantage Dual Special Needs Plan"
• Stated condition, not checked automatically: "Are capable at the time of enrollment of returning to or remaining in your home and community without jeopardy to your health and safety or you are permanently placed in a nursing home"
• Stated condition, not checked automatically: "Must be assessed as needing at least one CBLTSS for more than 120 days and the following:"
• Any one of these:
  • Stated condition, not checked automatically: "are assessed as needing at least limited assistance with physical maneuvering with more than two activities of daily living (ADLs)"
  • Stated condition, not checked automatically: "individuals with a Dementia or Alzheimer's diagnosis, assessed as needing at least supervision with more than one ADL."

Access route 2.1

• Where: Request an enrollment assessment with the New York Independent Assessor Program (NYIAP)
• How: Schedule an assessment with NYIAP.
• Phone: 1-855-222-8350

Offering 3: Program for the All-Inclusive Care for the Elderly (PACE)

With a PACE plan, health care and long term care services are provided by a PACE team of doctors, nurses, social workers, and other professionals who help coordinate all of the member’s Medicare, Medicaid, long term care, and drug benefits under one plan.

• Availability (owner codes): {"intake": "unknown", "type": "unknown"}

Conditions:

• All of these:
• Fact rule: recipient.age ≥ 55
• Fact rule: recipient.medicaid_eligible is true
• Stated condition, not checked automatically: "Reside in the Plan's service area"
• Stated condition, not checked automatically: "If Medicare eligible, you have evidence of Medicare Part A & B coverage and enroll in the PACE plan’s aligned Medicare Health Plan"
• Stated condition, not checked automatically: "Are capable at the time of enrollment of returning to or remaining in your home and community without jeopardy to your health and safety"
• Fact rule: recipient.nursing_facility_level_of_care is true
• Stated condition, not checked automatically: "Need at least one CBLTSS for more than 120 days."

Access route 3.1

• Where: Request an enrollment assessment with the New York Independent Assessor Program (NYIAP)
• How: Schedule an assessment with NYIAP.
• Phone: 1-855-222-8350

Evidence

• /name: "# Managed Long Term Care (MLTC)" (source, capture b9d2a9fa792aef1cf5ab11336f02c63339c52b57c32cbded9a7fdf2c44ea7c54)
• /authority: "Managed long-term care (MLTC) is a program that streamlines the delivery of long-term services and supports to people who are chronically ill or disabled and wish to stay in their homes and communities. Community based long term services and supports (CBLTSS) such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health. CBLTSS includes nursing services in the home, therapies in the home, home health aide services, personal care services in the home, adult day health care, private duty nursing, or Consumer Directed Personal Assistance Services (CDPAS)." (source, capture b9d2a9fa792aef1cf5ab11336f02c63339c52b57c32cbded9a7fdf2c44ea7c54)
• /frame: "Managed long-term care (MLTC) is a program that streamlines the delivery of long-term services and supports to people who are chronically ill or disabled and wish to stay in their homes and communities. Community based long term services and supports (CBLTSS) such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health. CBLTSS includes nursing services in the home, therapies in the home, home health aide services, personal care services in the home, adult day health care, private duty nursing, or Consumer Directed Personal Assistance Services (CDPAS)." (source, capture b9d2a9fa792aef1cf5ab11336f02c63339c52b57c32cbded9a7fdf2c44ea7c54)
• /caregiving_effect: "Managed long-term care (MLTC) is a program that streamlines the delivery of long-term services and supports to people who are chronically ill or disabled and wish to stay in their homes and communities. Community based long term services and supports (CBLTSS) such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health. CBLTSS includes nursing services in the home, therapies in the home, home health aide services, personal care services in the home, adult day health care, private duty nursing, or Consumer Directed Personal Assistance Services (CDPAS)." (source, capture b9d2a9fa792aef1cf5ab11336f02c63339c52b57c32cbded9a7fdf2c44ea7c54)
• /offerings/0/summary: "TitleDescription\nMLTC Partial Capitation (MLTCP)Age Requirements: 18 years and older \n \nCoverage Required: Medicaid \n \nThis line of business provides community based long term care and ancillary services, including home care and up to 3 months of nursing home care.\nMedicaid Advantage Plus (MAP)Age Requirements: 18 years and older \n \nCoverage Required: Medicaid and Medicare \n \nThis line of business provides integrated care including but not limited to behavioral health, primary care, acute, and long term care services.\nProgram for the All-Inclusive Care for the Elderly (PACE)Age Requirements: 55 years and older \n \nCoverage Required: Medicaid, Medicare and Private Pay \n \nThis line of business provides integrated care including includes all medically necessary services-primary, acute, and long term care." (source, capture b9d2a9fa792aef1cf5ab11336f02c63339c52b57c32cbded9a7fdf2c44ea7c54)
• /offerings/0/rules: "* Medicaid Eligibility Requirements\n * determined eligible for Medicaid by the Local Departments of Social Services or entity designated by the Department" (source, capture b9d2a9fa792aef1cf5ab11336f02c63339c52b57c32cbded9a7fdf2c44ea7c54)
• /offerings/0/rules: "* Community Health Assessment\n * To enroll in a MLTCP plan: \n * individuals must be assessed as needing community based long term care services and supports for more than 120 days and meet the Minimum Needs requirements as follows: \n * Needs at least limited assistance with physical maneuvering with more than two activities of daily living (ADL); or\n * Individuals that have a Dementia or Alzheimer's diagnosis and need at least supervision with more than one ADL" (source, capture b9d2a9fa792aef1cf5ab11336f02c63339c52b57c32cbded9a7fdf2c44ea7c54)
• /offerings/0/rules: "The eligibility criteria for Managed Long Term Care Partial Capitation (MLTCP), in accordance with Public Health Law § 4403-f, requires individuals to be assessed as needing community based long term services and supports (CBLTSS) for more than 120 days and the following:" (source, capture 7c10cfa7b70c1471708a1b85561d1e0796123c9e2059bd2d1ebcd14027b9a637)
• /offerings/0/rules: "* at least limited assistance with physical maneuvering with more than two activities of daily living (ADLs);\n* or individuals with a Dementia or Alzheimer's diagnosis, assessed as needing at least supervision with more than one ADL." (source, capture 7c10cfa7b70c1471708a1b85561d1e0796123c9e2059bd2d1ebcd14027b9a637)
• /offerings/0/rules: "* Are dual eligible (Medicaid and Medicare), age 21 and older, receiving CBLTSS for more than 120 days and meets the Minimum Needs Requirements.\n* Reside in New York State." (source, capture 7c10cfa7b70c1471708a1b85561d1e0796123c9e2059bd2d1ebcd14027b9a637)
• /offerings/0/rules: "* Dual eligible individuals, aged 18 through 20, who must be assessed as needing CBLTSS for more than 120 days and meet the Minimum Needs Requirements. \n* Non-dual eligible individuals, age 18 and older, who must be assessed as needing CBLTSS for more than 120 days and meet the Minimum Needs Requirements." (source, capture 7c10cfa7b70c1471708a1b85561d1e0796123c9e2059bd2d1ebcd14027b9a637)
• /offerings/0/access: "If you would like to request to enroll in a Managed Long Term Care (MLTC) plan, you must schedule an assessment with NYIAP by calling 1-855-222-8350TTY: 1-888-329-1541." (source, capture ad86224f6dd0c79c003c14c5bc73b7a7cadc4261729eeb3bd1004a07939675ae)
• /offerings/1/summary: "The MAP program is a type of plan for people 18 years of age or older who have both Medicare and Medicaid. The MAP plan works together with a Medicare plan to administer all of your Medicare, Medicaid, long term care, and drug benefits under one health care organization." (source, capture ef863ec00d674a23d42c256f3d20042f8cf425dbe4aaf07e4e3cea2caf105c03)
• /offerings/1/rules: "1. Are age 18 or older,\n2. Reside in the Plan's service area,\n3. Have Medicaid,\n4. Have evidence of Medicare Part A & B coverage,\n5. Enroll in the MAP plan’s aligned Medicare Advantage Dual Special Needs Plan\n6. Are capable at the time of enrollment of returning to or remaining in your home and community without jeopardy to your health and safety or you are permanently placed in a nursing home, and\n7. Must be assessed as needing at least one CBLTSS for more than 120 days and the following: " (source, capture ef863ec00d674a23d42c256f3d20042f8cf425dbe4aaf07e4e3cea2caf105c03)
• /offerings/1/rules: " * are assessed as needing at least limited assistance with physical maneuvering with more than two activities of daily living (ADLs); or\n * individuals with a Dementia or Alzheimer's diagnosis, assessed as needing at least supervision with more than one ADL." (source, capture ef863ec00d674a23d42c256f3d20042f8cf425dbe4aaf07e4e3cea2caf105c03)
• /offerings/1/access: "If you would like to request to enroll in a Managed Long Term Care (MLTC) plan, you must schedule an assessment with NYIAP by calling 1-855-222-8350TTY: 1-888-329-1541." (source, capture ad86224f6dd0c79c003c14c5bc73b7a7cadc4261729eeb3bd1004a07939675ae)
• /offerings/2/summary: "The PACE program is for people 55 years of age or older who have Medicare and Medicaid or Medicaid only. With a PACE plan, health care and long term care services are provided by a PACE team of doctors, nurses, social workers, and other professionals who help coordinate all of the member’s Medicare, Medicaid, long term care, and drug benefits under one plan." (source, capture 612a26c86d439bf3f8db1e53b655b250a7bb4a686ade1c12822f9a068cc5b388)
• /offerings/2/rules: "1. Are age 55 years or older,\n2. Reside in the Plan's service area,\n3. Have Medicaid,\n4. If Medicare eligible, you have evidence of Medicare Part A & B coverage and enroll in the PACE plan’s aligned Medicare Health Plan\n5. Are capable at the time of enrollment of returning to or remaining in your home and community without jeopardy to your health and safety,\n6. Need nursing home level of care, and\n7. Need at least one CBLTSS for more than 120 days." (source, capture 612a26c86d439bf3f8db1e53b655b250a7bb4a686ade1c12822f9a068cc5b388)
• /offerings/2/access: "If you would like to request to enroll in a Managed Long Term Care (MLTC) plan, you must schedule an assessment with NYIAP by calling 1-855-222-8350TTY: 1-888-329-1541." (source, capture ad86224f6dd0c79c003c14c5bc73b7a7cadc4261729eeb3bd1004a07939675ae)