Presentation on theme: "Changes to Medicaid Because of the Affordable Care Act, many more people will be eligible for Medicaid after January 1, 2014. Medicaid will be expanded."— Presentation transcript:
Changes to Medicaid Because of the Affordable Care Act, many more people will be eligible for Medicaid after January 1, Medicaid will be expanded and available to thousands more in New York State. But that is not the only change to Medicaid in New York State. New York State is changing the way it provides services for those who have Medicaid and need long-term care: Managed Long Term Care
The Old System vs. The New System Old Model (Fee for Service) New Model (Managed Long-Term Care Plans) Clients used any provider that accepts Medicare or Medicaid – not limited to any network Provider bills insurance (Medicaid and Medicare) directly Most services did not require prior approval of the plan Providers must be in- network All services and specialists must be approved by a Primary Care Provider The provider bills the managed care company- NOT Medicaid or Medicare The Plan gets a “capitation rate,” an amount of money per patient every month.
Kinds of Managed Long-Term Care Plans Partially-Capitated Long- Term Care Plans Fully-Capitated Long-Term Care Plans Cover certain Medicaid services only: long-term care Will be mandatory plan for Duals needing Long-Term Care NO Medicare coverage Members continue to use original Medicare cards or Medicare Advantage Plan and regular Medicare card for primary care and inpatient hospital care Cover all Medicaid and Medicare Services NOT mandatory to enroll Must use providers within network PACE plans offer services through a particular site and enrollee must be 55+
Managed Long-Term Care New York has had managed long term care plans for many years. Before now enrollment was voluntary. NOW in Erie county- all people: over the age of 21 who are eligible for both Medicaid and Medicare who require over 120 days of nursing-home level care ARE REQUIRED to enroll in a Managed Long Term Care Plan within the next month or so. Those who do no enroll themselves will be enrolled in a plan automatically.
Managed Long-Term Care All those in Erie County who already have Medicare and Medicaid and are already receiving over 120 days of nursing-home level care will receive a series of letters from New York Medicaid Choice, also known as MAXIMUS, the company hired by New York State to handle MLTC enrollment. Over 1000 people in Erie county will receive these letters this week:
New York State Managed Long-Term Care Announcement Letter This Letter is simply informing the individual that changes to their Medicaid are coming.
The Next Step… 60-Day Choice letter - About days after receiving that letter- another letter will be mailed: Requiring them to join one of the Managed Long-Term Care Plans within 60 days Or they will be randomly assigned to an MLTC plan. The letter will include: Guide to MLTC CONTACT LIST for plans :
Managed Long-Term Care Plans in Erie County Catholic Health Life (55+ only) Centers Plan for Healthy Living Fidelis Care at Home Total Aging in Place Program Wellcare Advocate MLTC United Choice MLTC
Picking a Plan Make a list of the agencies and other providers you want to see after you join a Plan. You can keep or change the providers you have now. Which Plans work with the home care agency and other providers you want ? New York Medicaid Choice can help you find out what Plan fits the best for your needs: You have the right to choose the Plan that best meets your needs.
Picking a Plan A nurse who works for the Plan will come to your home and do an assessment to determine what services and how many hours the new plan will provide you. This is called a Plan of Care. The assessment will last a few hours. You will be asked questions about your daily tasks and your abilities. You have the right to have a family member or any advocate there with you during this assessment. You do not have to decide right then if you want to sign up for the Plan. You have the right to see the Plan of Care before enrolling in any Plan
90 Day Transition Period All Managed Long-Term Care Plans MUST provide the same services and the same number of hours that you have been previously been getting for 90 Days after the switch, regardless of what the Plan determines is your Plan of Care. They must allow you to use with the same home care agencies and aides that were helping you before for 90 days or until an assessment is done- whichever is longer.
After the Transition Period After the 90 days, the Plan can reduce or end the services you had previously received. The Plan also may not work with the home care agencies and aides you have been using. The Plan will give you a WRITTEN NOTICE stating the amount of home care and other services they will begin to give you on Day 91 of your enrollment (after the Transition Period is over). This may be different- less or more- than you have been receiving before.
What Can I Do? Legal Services for the Elderly, Disabled, or Disadvantaged of Western New York can help you through this process if: You are confused about what plan or type of plan is best for you You were mandatorily enrolled in a Plan but want to be in a different plan You do not feel you were assessed fairly or accurately by the Plan’s nurse and do not agree with the Plan of Care You have received notice that your services or hours are being reduced and want help appealing that decision Any problems with the Plans- such as aides being late, missed transportation, case managers being unavailable. You have any other questions or problems about these changes to your Medicaid