Swimming Upstream

I got a call the other day from a man looking for home care for his 90-year-old mother. Currently receiving the services of a home care aid through the New York City agency CASA, his mother has to make a big decision. According to a letter she got from the NYS Health Department, she has just 60 days to enroll in a managed long-term care (MLTC) plan. If she doesn’t pick a plan that she thinks is best for her, the state will find one for her. They will automatically and randomly enroll her in a plan.

The son is worried. I’m not the first person’s he’s called. I can tell he’s confused, frustrated, definitely fixin’ for a fight.

I get it. Like any good son, the man wants the best for his mom. But with a letter, a general description of long-term managed care, and a list of New York’s MLTC plans, how does he decide?

Many caregivers will be faced with this same task over the next six months as New York State requires approximately 100,000 New Yorkers on Medicaid and Medicare who currently receive home care to enroll in managed long-term care. The pace of this transition is dizzying. The rules and regulations are coming out from the State at nearly the same time that they are being implemented.

I ask the man what was most important to his mother. He says, keeping her home care. On that score, he’s in luck. Under the mandatory enrollment regulations, MLTC plans are REQUIRED to accept the amount of home care that a person currently receives for 60 days, and they are REQUIRED to get a contract with the home care agency that is providing care. No fights necessary!

He is also worried about what would have to be done quickly, since his schedule is packed and he needs time to make time to be there for his mother to put things in motion. More good news for him: During mandatory enrollment, people who receive letters are assumed to be eligible for services. They don’t need to have an immediate nursing assessment prior to enrollment. Plans are required to do an assessment within 30 days of enrollment.

Picking the right plan

While those two things eased his mind, the challenge of picking the right plan, the best plan, loomed large for him, as it does for anyone embarked on this search. But there is help out there. I shared our nine-point to-do list:

  1. Prioritize what is most important to you. ICS is a MLTC plan, and we have a member who uses a certain brand of catheter that has helped him avoid urinary tract infections. Getting this brand of catheters is key to his quality of life. Ask yourself or your loved one: What is the thing that you need most to ease the challenges of your life and keep you healthy?
  2. Identify any special needs: Do you need a plan that specializes in serving people with disabilities or dementia, with MS, Spinal Cord Injury or comprehensive wheelchair services?
  3. Be sure to read the information that you received from New York State about choosing a MLTC plan.
  4. Find the plans that serve the geographic area where you live.
  5. Consult with an enrollment advisor at New York Medicaid Choice, which is charged by DOH with managing enrollment, by calling 1-888-401-6582 or TTY: 1-888-329-1541.
  6. Make a written list of your questions—for the plans you call and/or for NY Medicaid Choice.
  7. Call each plan that serves your area or check their website to get the answers to your questions.
  8. When calling a plan, be very clear that you are exploring plans and not ready to enroll in any plan; this will ensure that you are not enrolled in a plan you don’t want to join.
  9. Once you have decided on a plan, either call the plan directly or call NY Medicaid Choice to enroll. And congratulate yourself!

My caller had more questions, and I did my best to answer them. One came up that we needed to do some research to solve, and to consult with DOH. We made progress, but it was clear that we were both feeling our way. For the people enrolling, this is a new moment. For the plans like ours waiting to welcome many new enrollees in a short space of time, it is also a new moment.

I commended him on his advocacy and perseverance. I asked him for his patience as we swim upstream together in murky waters. I told him that while the ride may be wild, I am sure we will find our way.

To learn more about our MLTC plan, click here


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