Managed Long Term Care plans in New York are Medicaid plans that coordinate home- and community-based services for people who are chronically ill or disabled and want to stay out of a nursing home. Instead of Medicaid paying for each aide visit or therapy session separately, a private insurer receives a flat monthly payment per member and uses that money to arrange everything: home care, equipment, transportation, day programs, and more. For many New Yorkers who need help with daily activities for more than 120 days, joining one of these plans is not optional.1New York State Department of Health. Managed Long Term Care (MLTC)
Who Can Enroll
Eligibility turns on three things: your age, your clinical need, and your finances.
Age and Clinical Need
You must generally be at least 18 to join a Partial Capitation or Medicaid Advantage Plus plan. PACE sets its floor at 55.2New York State Department of Health. Program for the All-Inclusive Care for the Elderly (PACE) The clinical standard is the same across plan types: you need community-based long-term care services for more than 120 days. Think ongoing help with bathing, dressing, eating, or moving around at home. A short recovery from surgery will not meet it. A nurse verifies the 120-day threshold before you can enroll.3New York State Department of Health. Conflict-Free Evaluation and Enrollment Center (CFEEC) Frequently Asked Questions
Financial Limits
You also have to qualify for Medicaid. Many enrollees are dual-eligible with both Medicare and Medicaid, but Medicaid-only applicants can enroll too. For 2026, a single applicant in the aged, blind, and disabled category can have about $33,000 in resources and roughly $1,836 in monthly income. You can usually keep a home and a car as long as the home’s equity stays under $1,130,000.4New York State Department of Health. GIS 26 MA/03 – Medicaid Income and Resource Standards That equity cap goes away entirely if your spouse, a child under 21, or a blind or disabled child lives in the home.
If Your Spouse Stays at Home
When one spouse needs long-term care and the other does not, spousal impoverishment rules let the community spouse keep some assets and income. For 2026, the community spouse can hold between $74,820 and $162,660 in resources.5New York State Department of Health. Information Notice to Couples With an Institutionalized Spouse The monthly maintenance allowance runs from $2,643.75 to $4,066.50, depending on housing costs and other factors.6Medicaid.gov. CMCS Informational Bulletin – 2026 SSI, Spousal Impoverishment, and Medicare Savings Program Resource Standards Without these protections, couples would need to drain nearly all joint assets before coverage kicked in.
The Three Plan Types
New York offers three MLTC structures. The difference between them comes down to how Medicare and Medicaid are packaged.1New York State Department of Health. Managed Long Term Care (MLTC)
Partial Capitation
The most common type. The plan runs your Medicaid-funded long-term care — aides, therapies, equipment, transportation — while your Medicare side stays separate for doctors and hospitals. You keep seeing any Medicare-accepting provider. You juggle two systems, but you keep provider freedom. Partial Capitation also covers up to three months of nursing home care if you need temporary placement.
Medicaid Advantage Plus
MAP bundles everything together. One plan handles your Medicaid long-term care and your Medicare medical benefits, with one network and one care team. The convenience is real; the catch is that you have to use in-network doctors, which may mean leaving your current ones. You need both Medicare and Medicaid to join.1New York State Department of Health. Managed Long Term Care (MLTC)
PACE
The Program of All-Inclusive Care for the Elderly goes further. You must be 55 or older and meet nursing home level of care.2New York State Department of Health. Program for the All-Inclusive Care for the Elderly (PACE) A single team based at an adult day center manages your medical care, therapies, long-term supports, and social programming. It suits people who want structure and companionship built into their care, but you commit fully to the PACE team for everything.
What the Plan Covers
Once enrolled, your plan arranges and pays for services designed to keep you safely at home. Core benefits across all three plan types include:7New York State Department of Health. Managed Long Term Care (MLTC) Covered Services
- Home health aides and personal care assistants for bathing, dressing, meal preparation, and daily tasks
- Physical, occupational, and speech therapy
- Adult day health care with meals, supervision, and social activities
- Durable medical equipment such as wheelchairs and hospital beds
- Non-emergency transportation to medical appointments
- Dental, vision, and hearing services, including eyeglasses and hearing aids
- Podiatry for conditions like diabetic foot care
- Up to three months of nursing home care under Partial Capitation
A care coordinator assigned by your plan assesses what you need and writes a care plan listing the type, frequency, and duration of each service. That coordinator is your contact for adjusting things as your health changes.
Choosing Your Own Caregivers Through CDPAP
If you would rather pick your own aides than accept whoever the plan sends, the Consumer Directed Personal Assistance Program lets you hire, train, and supervise your own workers. You can hire friends or certain family members, though not your spouse, your designated representative, or the parent of a consumer under 21.8New York State Department of Health. Consumer Directed Personal Assistance Program (CDPAP) CDPAP runs through MLTC plans. A fiscal intermediary handles payroll, taxes, and insurance.
How Enrollment Works
Three steps: an independent clinical assessment, picking a plan, and waiting for coverage to start.
The CFEEC Assessment
Before any plan can take you, the Conflict-Free Evaluation and Enrollment Center (operated by Maximus) sends a registered nurse to assess you at home, in the hospital, or wherever you are. The nurse uses the Uniform Assessment System to confirm you need services for more than 120 days.3New York State Department of Health. Conflict-Free Evaluation and Enrollment Center (CFEEC) Frequently Asked Questions Have your medical history, current medications, recent hospitalizations, doctors’ contacts, and proof of active Medicaid ready. The assessment is independent on purpose: the plans themselves cannot decide who qualifies.9New York State Department of Health. Conflict-Free Evaluation and Enrollment Center Fact Sheet
Picking a Plan and Starting Coverage
Once cleared, you pick a plan that serves your county. The State Department of Health keeps a searchable directory, and NY Medicaid Choice (also run by Maximus) will help you compare plans at 1-888-401-6582.10NY Medicaid Choice. Contact Us When you compare, ask which home care agencies the plan uses, whether your current providers are in-network, and how fast services can start.
Coverage start dates hinge on a monthly cutoff. The pull-down time is noon on the 20th of the month. Enrollments processed before that cutoff generally start the first day of the following month; anything processed after waits an extra month.11New York State Department of Health. Managed Long Term Care Policy 21.04 – Managed Long Term Care Partial Capitation Plan Enrollment Lock-In After enrollment, the plan sends your ID card and handbook, and your care coordinator schedules a home visit to finalize services.
The Lock-In Rule Most People Miss
After enrolling in a Partial Capitation plan, you have 90 days to switch for any reason. Miss that window and you are locked in for the next nine months.11New York State Department of Health. Managed Long Term Care Policy 21.04 – Managed Long Term Care Partial Capitation Plan Enrollment Lock-In During lock-in, you can only move to another plan if you can show “good cause,” which generally means the plan is failing to provide covered services or lacks providers where you live. You ask NY Medicaid Choice to make the good cause determination. Once the nine months are up, you can switch freely. Every switch resets the clock: a new 90-day grace period, then a new nine-month lock-in.
When the Plan Removes You
Plans can disenroll you involuntarily in a handful of situations: you move out of the service area, you are absent from the area for more than 30 consecutive days, you are hospitalized for 45 or more consecutive days under a Partial Capitation plan, or you no longer meet the clinical criteria.12New York State Department of Health. MLTC Policy 24.02 – Involuntary Disenrollment You have the right to appeal.
When the Plan Cuts or Denies Services
Plans can deny a new request, cut your current hours, or terminate a service. That is called an adverse benefit determination, and you can fight it. The deadlines matter.
You have 60 days from the denial notice to file an internal appeal with the plan. The plan has 30 days to decide. If waiting could harm your health, ask for an expedited appeal, which must be decided in 72 hours.13eCFR. 42 CFR Part 438 Subpart F – Grievance and Appeal System Whoever decides your appeal cannot be the person who issued the original denial, and must have appropriate clinical expertise if medical necessity is at stake.
Here is the piece worth memorizing. If the plan is reducing or terminating services you already have, file your appeal within 10 days of the denial notice. Do that, and your current services must stay in place, unchanged, while the appeal is pending, even if the authorization has expired.14New York State Department of Health. MLTC Policy 14.05 Miss the 10-day window and you lose coverage of the disputed hours while you wait.
If the plan upholds the denial, you can request a state fair hearing before an administrative law judge within 90 to 120 days of the plan’s final decision. Ask for aid-continuing at the hearing level and the plan has to keep services going until the judge rules.13eCFR. 42 CFR Part 438 Subpart F – Grievance and Appeal System If the plan botches the required notices or deadlines along the way, you are treated as having exhausted the internal appeal and can go straight to a fair hearing.
Estate Recovery After Death
One thing many families only learn about later: MLTC services are not free in the long run. Federal law requires every state to recover Medicaid costs from the estates of beneficiaries who were 55 or older when they received services.15Medicaid.gov. Estate Recovery New York reaches not just probate assets but also property passing by joint tenancy, living trusts, and life estates.16New York State Department of Health. Important Information Regarding Medicaid Estate Recovery
Recovery is deferred while a surviving spouse is alive, or while a child under 21 or a blind or disabled child of any age survives. It is also deferred against the home while a qualifying sibling (with an equity interest and at least a year of residence before the recipient was institutionalized) or a qualifying adult child (two or more years of residence providing care that delayed institutionalization) still lives there.
If no deferral applies, the estate’s representative has 30 days after receiving a Medicaid claim to apply for an undue hardship waiver. New York recognizes hardship when the asset is the beneficiary’s sole income-producing property, such as a family farm, or when the home’s value is no more than 50 percent of the average selling price in the county. Families should talk about this before enrollment, because options narrow once services have started.