New York’s New Medicaid Regulations: What Brooklyn Seniors and their Families Need to Know

New York State Medicaid regulations are changing. This means that the way New York’s chronically ill and elderly get their services will soon be changing too. New rules require all Medicaid patients who need long term care to join a Managed Long Term Care health plan—called MLTC for short—in order to keep these services. Here’s what Brooklyn seniors and their families need to know:

How Does a Medicaid MLTC Plan Work?

Medicaid MLTC plans help people who are chronically ill or disabled and who need assistance with daily activities such as walking, dressing, bathing or preparing food so that they can live safely at home instead of going to a nursing home.

For decades, the not-for-profit Visiting Nurse Service of New York has worked to create innovative healthcare solutions that address the complex needs of this vulnerable population—many of whom are at risk for falling between the cracks in our healthcare system, especially when they become isolated and live alone.

What Do I Need to Do?

Many New Yorkers have already started receiving letters notifying them that they must soon decide which MLTC plan to join. Individuals have 60 days to make a choice after receiving the letter. If someone does not choose a plan, Medicaid will automatically select one for them.

The most important thing to do right now is to watch your mailbox for the letter that will soon come from the NY Department of Health. The letter will provide helpful phone numbers and a list of Medicaid MLTC plans that you can choose from. Share the letter with your doctor, a family member, or someone you trust to help you make healthcare decisions. You might also want to speak to your CASA office or local Social Services office.

How is Switching to a MLTC Plan Better for Me?

Your MLTC plan will arrange for all of your long term care services. One of the advantages to a comprehensive plan like VNSNY CHOICE MLTC is that each member has a dedicated Nurse Care Manager—a registered nurse—who creates a personalized care plan, supervises all of their care and serves as a liaison with the primary care physician. The nurse and her team serve as the “eyes and ears” for the physician, monitoring the physical and emotional well-being of each member—often noticing subtle, easily overlooked changes that could indicate a serious health risk. They build strong relationships with each member, facilitating communication among all those who provide care, including the member’s family. Without this kind of consistent, proactive attention, many elderly New Yorkers who are challenged with multiple chronic conditions end up in the emergency room or hospitalized with serious illnesses that could have been avoided.

Do I Have to Switch Doctors?

As long as physicians agree to work with the plan, there’s no need to switch doctors. It’s always a good idea to ask if the MLTC plan you’re considering will change coverage for important medical benefits such as doctor visits, hospitalizations, emergency room care, and prescription drug coverage. VNSNY CHOICE has the largest MLTC health plan in the state, and doctors and specialists are well acquainted with our nurses and other health professionals. Because we are trusted and respected by so many care providers, transition from another plan is usually seamless—we even provide experts to help you navigate the paperwork.

How Do I Choose the Right MLTC Plan?

MLTC works best when the lines of communication are free and clear every step of the way. Consistency and trust are important too. At VNSNY CHOICE, a registered nurse works with each new member and his or her physician—sometimes with family caregivers as well—to create a customized care plan that takes into account each person’s challenges and concerns. Some things to look for include:

• A simple application process and qualified experts to help navigate paperwork
• Someone who speaks your language—we deliver care in 25 languages at VNSNY CHOICE MLTC
• Trustworthy home health aides supervised by nurses who know your medical history
• A 24/7 Nurse Support Hotline that is available 365 days a year
• Access to adult day centers
• Resources for family caregivers

Will I Still Need to Call CASA or Social Services?

No, the letter you receive from NY DOH will include a list of Medicaid MLTC health plan plans that you can choose from. The plan you select will then arrange all your long-term care services. After you join a plan, your Medicaid CASA office or local Social Services office will no longer be in charge of approving your services.

Where Can I Get More Information?

New York Medicaid Choice counselors can tell you which plan works with your home care agency or other providers you are currently using.  You can reach them at 1-888-401-6582. For more information about VNSNY CHOICE Health Plans, call 1-855-282-4642 or visit www.VNSNYCHOICE.org.

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