Greetings – Here are some Medicaid updates from the Evelyn Frank Legal Resources Program, with links for where to find more information.
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New Step in MLTC Enrollment - Conflict-Free Eligibility & Enrollment Center (CFEEC)

Anyone approved for Medicaid after Oct. 1, 2014 in MANHATTAN or the BRONX who is seeking Managed Long Term Care will need to first contact NEW YORK MEDICAID CHOICE and request a CFEEC assessment.  If that assessment – conducted by a nurse in the client's home, hospital or nursing home – finds the person eligible for MLTC, then the person can enroll in an MLTC plan.
Why add this step?  The federal Medicaid agency - CMS - requires this "conflict-free" assessment to eliminate the conflict of interest when MLTC plans decide who is eligible for MLTC.  A scandal erupted in 2012 when MLTC plans were enrolling people recruited to Social Adult Day Care programs, who did not need home care at all - costing the Medicaid program millions of dollars.  Now, the CFEEC will deny eligibility to people who do not need Medicaid personal care.  People who just need Housekeeping services, not assistance with personal care, are not eligible for MLTC and can apply for Medicaid housekeeping at their local Medicaid office.  This independent assessment is also intended to prevent MLTC plans from rejecting high-need consumers.  However, we fear that plans can still use pretexts to discourage enrollment of consumers who need costly care.
NEXT COUNTIES STARTING the assessment centers --
  • Region 2 – November 2014: Kings, Queens, Nassau, & Richmond
  • Region 3 – February 2015: Westchester & Suffolk
  • Click here for FAQ with schedule for rest of state and other information.  Also see
Will this delay enrollment into MLTC?  Probably.  MLTC plans may not accept an enrollment without confirmation from CFEEC that you are MLTC-eligible.  That confirmation is valid for 60  days.   The State FAQ (Q13) says the CFEEC assessment can be done while Medicaid application is pending, but since a Medicaid application can take more than 60 days - it can be risky.  It is also unclear whether the consumer must only sign an MLTC plan enrollment form within 60 days of the CFEEC assessment, or must actually be enrolled in the plan by that date - the difference can be significant.

Expansion of Mandatory Managed Care and MLTC to Include Nursing Home Residents Delayed until 2015

Still awaiting CMS approval, NYS has now delayed until January 1, 2015 the new requirement that mainstream Medicaid managed care plans as well as MLTC plans must now provide nursing home services.  People who become permanent residents in nursing homes after January 1, 2015 will have to join a managed care or MLTC plan.  (One is only considered a "permanent" nursing home resident for this purpose if they have applied for Nursing Home [institutional] Medicaid, with the 5-year Lookback period, and that application has been approved.   It will NOT be required to join an MLTC or managed care plan just upon entering a nursing home.)

This will start in NYC, Long Island and Westchester in January 2015 and then expand upstate in April 2015.  One reason for delayed approval is that the State has not yet launched an Ombudsman program to help consumers - expected to start around December 2014. 

Fully Integrated Dual Advantage (FIDA) Demonstration program Delayed Until January 1, 2015

This demo has been delayed until January 2015.  All MLTC and nursing home residents who have Medicaid and Medicare in NYC, Long Island and Westchester will receive notices telling them they may join a FIDA plan with the right to “opt out” if they don’t want to join. If they don’t opt out in 60 days, they will be automatically assigned to a plan.  These plans will be like Medicaid Advantage Plus (MAP) plans – they will control and authorize all Medicare and Medicaid services.   Read more about it here

Good news and Bad news in “Spousal Impoverishment” Protections

The good news is that any married MLTC recipient in NY State may now be budgeted to have the same spousal impoverishment protections that used to exist in the Lombardi program, and that are used in nursing home budgeting.  See more in this article

The bad news is that the State Dept. of Health issued a policy that prohibits the use of a pooled trust for married individuals receiving MLTC services.  The State's view is that pooled trusts are not legally allowed when spousal impoverishment protections are used.  However, for some married couples, the spousal impoverishment protections are less favorable than using a pooled trust.  This is mainly true where the "community spouse" who is not receiving the MLTC services is working or has other income, so does not need the "spousal impoverishment allowance."  In such cases, the MLTC recipient's income cannot be placed into a pooled trust, according to the State.

So far, Suffolk County DSS is the only county we have heard of that is already sending notices to couples to rebudget their Medicaid.  The NYS Bar Association Elder Law Section has met with the State to protest this change.  In the meantime, we suggest that you request a fair hearing if you receive a notice that is adverse.  Stay tuned.     

MLTC Schedule for Expanding to Upstate Counties – and other MLTC Updates

Webinars and Live Trainings Available on MLTC and the new FIDA program.

The Evelyn Frank Legal Resources Program is conducting various training programs on MLTC and FIDA.
  1. OCTOBER 28th  9:30 - 11 AM.  Lower East Side Inter-Agency Council on Aging LOCATION:  The Education Alliance at 197 East Broadway, Manhattan.   No charge.  Trainer:  David Silva.
  2. DEC. 3rd  1:00 - 5:00 PM (LIVE AND WEBINAR).   Sponsored by the New York Chapter of Professional Geriatric Care Managers and NYLAG.  LOCATION:    American Jewish Committee, 165 East 65th Street, NYC, NY.   CLE credit available,  NASW CEU's pending.  Fee will be charged.  Trainer:  Valerie Bogart.   Download announcement and registration form here.         
  3. Jan. 27, 2015 - NYSBA Elder Law Section Annual Meeting.  David Silva will be presenting on MLTC and FIDA - see NYSBA website for registration. 
  4. WEBINAR VIEW - Free webinar recorded in April 2014 (2.25 hours) on MLTC and FIDA.  Trainer:  Valerie Bogart.   Webinar and PowerPoint, along with Fact Sheets on MLTC can be downloaded here.   Webinar still current except omits discussion of Conflict-Free Eligibility and Enrollment Center discussed above and some other updates.

NYLAG Brings Class Action Against the State for Due Process Violations by Medicaid Managed Care and MLTC Plans

The complaint addresses the widespread practice of Medicaid Managed Care and MLTC plans reducing or discontinuing home care services with no notice or improper notice.  Consumers have the right to a written notice before an MLTC or managed care plan reduces or discontinues home care services, and the right to request an “internal appeal” of that reduction with “aid continuing” while the appeal is being held. If that appeal is denied, the plan should send a second notice if it is denying the appeal, giving the right to request a fair hearing again with “aid continuing” until the hearing is held and decided.  Consumers are also entitled to proper notice when their requests for increased home care services are denied.  Please notify NYLAG of any cases where consumers lost home care services without being given proper written notice and appeal rights.  Contact: or rwallach@nylag.orgRead more...
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