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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In this issue -

1.   Guildnet MLTC Members Receive Notices about Transferring to New Plans before Guildnet Closes Jan. 2019   

2.    Four FIDA plans Closing January 2019

3.   Register for Legal Education Program on MLTC and NYS Medicaid Changes in 2018 - Nov. 14th - Conducted by NYLAG Evelyn Frank Legal Program

4.   Comments due Nov. 23rd on NYS Proposal to Exclude People Placed in Nursing Homes for 3+ Months from MLTC Plans 

1.   Guildnet Members Receive Notices about Transition to new Plans after Guildnet Closes Jan. 1, 2019  
This notice was sent to all Guildnet NLTC members on Oct. 19, 2018 by New York Medicaid Choice, the Medicaid managed care enrollment broker for NYS. The notices state that if Guildnet members don't select a new plan by 12/19/2018, they will be auto-assigned to a new plan for January 1st. "The Plan you select will continue to honor your current plan of care for 120 days from the  date that you transfer to the new plan." These "transition rights" are required  by the NYS DOH MLTC Policy 17.02 which requires continuity of care in the new plan after a plan closing.  

Read about strategies for helping Guildnet members protect their rights to continuity of care and continuity of their preferred aides in this article. You can learn more about these strategies by attending our CLE/CEU Training on November 14th. See info here

Where to Get Help: If you have questions about how these changes affect you or your client, call the ICAN Ombudsprogram at 1-844-614-8800. If a plan employee or an employee of the home care agency that provides their MLTC home care services tells them that they should change plans or that the plan is closing, please report this to ICAN or directly to the State Dept. of Health MLTC Complaint line at 1-866-712-7197 or e-mail 

Four FIDA plans are  closing in January 2019:  
  1. Guildnet GoldPlus FIDA plan         NYC only (418 members)  -they will be auto-enrolled in Healthfirst FIDA if they don’t select a different plan by Dec. 19th 
  2. Village Care Max Full Advantage   NYC only (23 members) 
  3. MetroPlus FIDA                              NYC only (205 members)
  4. AgeWell NY FIDA plan                   NYC, Suffolk, Nassau, & Westchester (247 members)           
                    NOTE that Agewell was the SOLE FIDA plan in Suffolk county.  

Warning that as of now, MLTC Policy 17.02 described above for Guildnet MLTC, does not specifically apply to FIDA. However, if participants in terminating FIDA plans choose to switch to another FIDA plan, they will be given a 90-day transition period per the 3-way contract (§ It is less clear what transition rights members of a closing FIDA plan have if they switch to an MLTC plan.  Stay tuned for more on that. This is especially critical for Suffolk County residents, where the plan that is closing - Agewell FIDA - was the ONLY FIDA plan, so they do not have the option of switching to another FIDA plan. 

Additionally, if a member of a closing FIDA plan decides to switch to an MLTC plan instead of to another FIDA plan or another "fully capitated" plan like PACE or Medicaid Advantage Plus, they must remember to select and enroll in a Medicare Part D prescription drug plan for January 1, 2019. Before, the FIDA plan covered their drugs. Now, they need to enroll in a stand-alone plan. For more info on Medicare Part D see a training manual and other info here and see NYS plans in 2019


3.   Register for Half-Day Training & CLE Program on

MLTC and NYS Medicaid Changes in 2018 and Advocacy Tips

NY Aging Life Care Association, Sponsor
November 14, 2018 at 1:00 PM - 5:30 PM
followed by Cocktail Reception 5:30 - 7:00 PM

NY Academy of Medicine: 1216 5th Avenue (103rd St) NY NY

Trainers:  Valerie Bogart & Peter Travitsky,
NYLAG Evelyn Frank Legal Resources Program

CLE and CEU credit  

Download the announcement for information about  topics, fees, how to request a hardship waiver, CEU and CLE credit, and link to register online.  

4.  Comments due Nov. 23rd on NYS Proposal to Exclude People Placed in Nursing Homes for 3+ Months from MLTC Plans   

In late September 2018, NYS DOH submitted a request to CMS to change the MLTC program to exclude people permanently placed in a nursing home for 3 months from MLTC plans. The State's proposal and accompanying documents are posted on the State's MRT webpage hereThis is a reversal of the policy in effect since 2015, described in this article.

The deadline to submit comments to CMS was Friday Oct. 26, 2018. Many consumer advocacy organizations submitted comments which are available on the CMS website hereClick on these links for comments by NYLAG, Legal Aid Society and other organizationsNYLAG's comments on the rule state that the three-month "clock" should not start ticking toward disenrollment if the member intends to return home. Disenrollment from an MLTC plan will make it much harder to return home. The proposed procedures do state that the period in which Medicare is covering all or part of a rehab stay will not count toward the 3 months of permanent placement. Also, NYLAG and other consumer advocates urge that plans must give notice of a decision to consider them "permanently placed," which the consumer should have the right to appeal. These decisions must be made with involvement of the consumer, not unilaterally by a managed care plan or nursing home. Please see other suggests in our comments

The State has reopened the comment period on this change. See this notice. Consumers may submit comments to the State before Nov. 23, 2018. Comments can be submitted via email to In the subject line DOH asks you to please indicate "Proposed NH Benefit/Lock In 1115 Amendment Comments".

Please Support the Evelyn Frank Legal Resources Program!

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Your donations help us deliver this important news to you through our website and newsletters, and help us help thousands of vulnerable New Yorkers who depend on us to advocate for their access to Medicaid services and long term care needed for them to stay safe in their homes. We very much appreciate your support!

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