What is Managed Long Term Care?
Managed Long Term Care is how New York delivers Medicaid long-term care. Instead of Medicaid paying providers directly for each service, you enroll in a health plan approved by the New York State Department of Health, and that plan manages your long-term care benefits.
The plan covers things regular health insurance usually does not: a home health aide or personal care aide helping with bathing and dressing, adult day care, physical and occupational therapy, medical supplies, transportation to appointments, and nursing home care. Medicaid pays the plan. You do not pay a premium.
When you enroll you get a care manager, which is the part families tend to appreciate most. That is one person to call when hours get cut, when the aide is not showing up, or when something changes and you need the care plan revisited.
Who has to join an MLTC plan in New York?
Enrollment in an MLTC plan is mandatory if all of the following are true. You have both Medicaid and Medicare. You are 21 or older. You need community-based long-term care services for more than 120 days. And you meet the Minimum Needs Requirements described in the next section.
Mandatory enrollment applies across New York State. If that describes your situation, you cannot get ongoing Medicaid home care outside of an MLTC plan.
Enrollment is voluntary for a couple of other groups: people with both Medicaid and Medicare who are 18 to 20, and people with Medicaid but not Medicare who are 18 or older. Both still have to meet the needs criteria. If the person needing care is under 21, MLTC is usually not the route. Children and young adults typically get Medicaid home care through different programs, so the first step is finding out which pathway applies rather than assuming an MLTC plan is the answer.
If you have Medicaid but not Medicare, you may already be getting long-term care through a Mainstream Medicaid Managed Care plan, which covers your regular medical care as well. In that case you probably do not need a separate MLTC plan. Call the plan you already have and ask.
The 2025 eligibility change you need to know about
This is the change that catches families off guard, so it is worth being precise about.
For anyone assessed on or after September 1, 2025, qualifying for MLTC requires more than just needing care for 120 days. You also have to meet what the state calls the Minimum Needs Requirement, and there are two ways to meet it.
The standard threshold is needing at least limited assistance with physical maneuvering for more than two activities of daily living. In practice that means three or more of the following: bathing, dressing, toileting, transferring, eating, personal hygiene, bed mobility, and moving around inside or outside the home.
The second path applies if there is a documented diagnosis of Alzheimer’s or dementia. In that case the threshold is lower: needing at least supervision with more than one activity of daily living, so two or more. The diagnosis has to be documented, and the documentation has to be provided. Without it, the lower threshold does not apply.
The previous standard required assistance with two ADLs. Moving to three is a real change, and some people who would have qualified in 2024 do not qualify now.
If you are already enrolled
People who were enrolled in MLTC, personal care services, or consumer directed services before September 1, 2025 keep what the state calls legacy status, and are reassessed under the old criteria as long as they stay continuously enrolled. That protection can be lost. A gap in enrollment of a month or more, or disenrollment after a long nursing home stay, means reapplying under the new standard. If you are enrolled now, staying enrolled matters more than it used to.
What kinds of MLTC plans are there?
There are three types of plans to know about, and which ones are available to you depends on whether you have Medicare in addition to Medicaid.
MLTC Partial Capitation
This is the most common option and the one most people mean when they say “MLTC.” It covers only your long-term care. Your regular medical care, doctors, hospitals, prescriptions, stays with Medicare, and nothing changes about how you see your existing providers. You carry both cards.
Partial capitation covers home care including personal care and home health aide services, adult day health care, therapies, medical supplies, transportation to medical appointments, dental care, and short nursing home stays.
Medicaid Advantage Plus (MAP)
MAP combines your Medicare and Medicaid benefits into a single plan with one care manager handling everything: long-term care, doctor visits, hospital, prescriptions, behavioral health. The trade-off is a closed Medicare network. You use the plan’s providers rather than any provider that takes Medicare.
MAP has become the main integrated option in New York and enrollment has grown substantially. You need both Medicare and Medicaid.
PACE (Program of All-Inclusive Care for the Elderly)
PACE also brings everything under one plan, and it is built around a local center where a team of doctors, nurses, and therapists handles your care. Some centers include meals and adult day programming.
PACE has its own requirements: you have to be 55 or older, need a nursing home level of care, be able to live safely at home with support, and live in an area a PACE center serves. That last one is the real constraint, since there are only about ten PACE programs statewide and they cover specific counties.
One thing worth knowing: PACE is exempt from the September 2025 Minimum Needs Requirement, and it has no lock-in period.
If you read about FIDA somewhere
Fully Integrated Duals Advantage, or FIDA, comes up in older articles about New York long-term care. That program ended on December 31, 2019 and is no longer an option. The separate FIDA-IDD program for people with intellectual and developmental disabilities was scheduled to end December 31, 2024. If a guide you are reading describes FIDA as a current choice, it is out of date, and probably out of date about other things too.
What if you need care right away? The Immediate Need process
The full process above takes time, and sometimes the need is urgent. If someone is coming home from the hospital with no care in place, or a situation at home has suddenly gotten unsafe, New York has an Immediate Need process meant for exactly that. It is a faster track to getting personal care or consumer directed services authorized when waiting for the standard timeline is not realistic.
Immediate Need requests go through your local Medicaid office or, if you are already enrolled, your managed care plan. FreedomCare does not process or submit Immediate Need applications, so if you think this applies to you, contact your local Medicaid office or your plan directly to start it. If you are not sure where you stand or who to call, reach out to us and we can help you figure out the right next step.
How to sign up for an MLTC plan
The process runs through the New York Independent Assessor, usually called NYIA. This replaced the old Conflict-Free Evaluation and Enrollment Center in May 2022. If someone tells you to call CFEEC, they are working from old information.
Step 1: Make sure Medicaid is in place
You need active Medicaid before NYIA will assess you. If you are not enrolled yet, that comes first, through NY State of Health, ACCESS HRA, or your local department of social services. This part can take a while, sometimes a few months, so starting early matters.
Step 2: Call NYIA to schedule your assessments
Call NYIA at 1-855-222-8350 (TTY 1-888-329-1541) and follow the prompts for a long-term care assessment. Have the Medicaid number ready. The person needing care has to be on the call. An authorized representative can call on their behalf if they are already on file with NYIA.
NYIA schedules two appointments, and both are supposed to happen within 14 days of that call.
Step 3: Choose a plan
Once NYIA determines you are eligible, you will get a notice, and from there you pick a plan. New York Medicaid Choice is the state’s enrollment broker and their counselors will walk you through what is available in your county. Call 1-888-401-6582 (TTY 1-888-329-1541). If you do not pick a plan, one gets assigned to you, so it is worth making the call.
Enrollments take effect on the first of the month. Paperwork completed by around the 20th generally means coverage starting the following month.
What the NYIA assessment is like
The NYIA process has two parts, and both can be done in your home or remotely by video.
The first is a Community Health Assessment, conducted by a nurse. They will go through what you can and cannot do on your own: walking, bathing, dressing, getting in and out of bed, preparing meals, managing medications. Be straightforward about the hard days, not the best days. The assessment drives how many hours you get approved, and people routinely undersell their needs out of pride or habit.
The second is a clinical appointment with a health care provider from the Independent Practitioner Panel. This person issues the practitioner order. Note that this is not your own doctor, and under the current process you do not need to get an order from your physician the way you did years ago.
If the care plan being considered runs to more than 12 hours a day, a third review by an Independent Review Panel may be required.
You should get a written notice of the outcome within about two weeks of the second appointment.
Helpful tip
A common reason for denial is that the assessor concludes you have not needed hands-on help recently. If the person needing care has good days and bad days, make sure the assessment reflects what assistance actually looks like across a normal week, not just how things happen to be that afternoon.
Who actually provides your care once you are enrolled
This is the part that confuses people, because approval and delivery are two different things.
Your MLTC plan authorizes the services and decides how many hours you get. The plan does not usually employ the aide who shows up at your door. It contracts with licensed home care services agencies, and one of those agencies is the one that actually staffs your case: hiring the aide, training and supervising them, and handling the schedule. So the plan approves the care, and the agency delivers and manages it. Keeping those two roles separate in your head makes the rest of the process easier to follow.
FreedomCare is a licensed home care services agency in New York, providing personal care aide and home health aide services. If your plan authorizes hours and you want us providing that care, you can ask for us by name. If you are choosing or switching plans and want to keep working with us, call (866) 506-9284 and we will tell you which plans we are contracted with in your county.
You are allowed to have a preference about who provides your care. Plans contract with a limited number of agencies, so not every agency works with every plan, but within your plan’s network the choice is yours to make. This is worth checking before you enroll or switch, because it is one of the most common questions we hear. If there is a specific agency you want, confirm it is in-network with the plan you are considering first. Otherwise you can end up enrolled in a plan that does not contract with the agency you had in mind. Keep in mind too that not every MLTC plan operates in every county, so the plans available to you depend on where you live.
Can you have assets and still join an MLTC plan?
To join an MLTC plan you generally need to be eligible for Medicaid, and Medicaid has limits on income and assets.
Having assets above the limit does not automatically end the conversation. New York has established paths for people in that position, including spending down excess income and pooled income trusts. These are worth talking through with someone who knows the rules rather than assuming you do not qualify.
If you are close to the line, an elder law attorney is worth the consultation. The rules around what counts, what is exempt, and how transfers are treated are specific enough that guessing tends to be expensive.
How to change your MLTC plan
You used to be able to switch MLTC plans whenever you wanted. That is no longer true, and this trips up a lot of people.
When you enroll in a partial capitation plan, you get a 90-day grace period during which you can switch to another plan for any reason. After those 90 days, you are locked in for the next nine months unless you can show good cause.
Good cause covers things like the plan not meeting your care needs, the plan dropping your home care agency without an adequate alternative, moving out of the service area, or your preferred provider being in a different plan’s network. New York Medicaid Choice decides whether a request qualifies.
After the lock-in ends you can switch freely again, but each new enrollment starts the clock over: another 90-day grace period, then another nine months.
PACE works differently. There is no lock-in, and PACE participants can disenroll at any time.
To switch, contact New York Medicaid Choice at 1-888-401-6582. Changes take effect on the first of the month.
How to appeal if your plan denies or cuts your hours
If your plan denies services, reduces your hours, or ends care you were getting, you can challenge it. The order of steps matters, and getting it wrong can cost you the appeal.
First: file a plan appeal
You have to start with your plan, not the state. This is called a plan appeal, and you request it from the plan directly. Call the number on your plan card and ask for appeals and grievances, or go through your care manager. The plan reviews and issues what is called a Final Adverse Determination if it does not rule in your favor.
Then: request a Fair Hearing
Once you have the plan’s decision, you can request a State Fair Hearing, where an administrative law judge from the Office of Temporary and Disability Assistance reviews the case. The deadline is 120 days from the plan’s appeal decision.
You can request a Fair Hearing online, by phone at 800-342-3334, in person at your local Medicaid office, or by mail to the Office of Administrative Hearings, P.O. Box 1930, Albany, NY 12201-1930.
Keeping your services during the appeal
This is the deadline that matters most and the one people miss. If you want your current hours to continue while the appeal is pending, you generally have to act within 10 days of the notice, and you have to specifically ask for services to continue. Waiting even a couple of weeks can mean going without care while the appeal plays out.
Read the notice you received carefully. It states the effective date of the change, and that date drives everything. While your appeal is pending, keep following your current plan of care and keep reviewing any notices that arrive, unless one of them tells you to do something different. Plans and the state will send updates as the case moves along, and missing a step or a deadline buried in one of those letters is an easy way to lose ground you did not need to lose.
Free help is available
The Independent Consumer Advocacy Network (ICAN) helps New Yorkers with MLTC problems at no cost, including appeals. They are independent of the plans. Call 1-844-614-8800.
Where to start
If you are at the beginning of this, the order is: get Medicaid in place, call NYIA at 1-855-222-8350 to schedule the assessments, then call New York Medicaid Choice at 1-888-401-6582 to choose a plan.
If you are caring for someone in New York and want help figuring out where you are in this process, call FreedomCare at (866) 506-9284. We can tell you what step you are actually on and what comes next.
