Resources and information

Fair Hearing Rights Changing for MLTC and Managed Care Members | April 2018

On May 1, 2018, New York State will implement massive changes in appeal rights for members of Medicaid managed care plans, including members of Managed Long Term Care plans.  These changes in federal Medicaid regulations governing Medicaid managed care plans were made by the Obama Administration.  Plan members must first request an internal "plan appeal" by the managed care or MLTC plan, and receive an adverse appeal decision by the plan, before requesting a fair hearing.  This article, by the New York Legal Assistance Group, explains the new appeals procedures, and the few exceptions to the requirement to "exhaust" the plan appeals, with a comparison to the existing procedures.  The article includes links to slides and a recording of a webinar on this topic as well.

New York Legal Assistance Group prepared a fact sheet for consumers which describes the changes and explains what people can do if they need help or more information.

MLTC Tip Sheets | June 2017

The Workgroup for People with Medicare and Medicaid, a project of the Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE), created tip sheets about Managed Long Term Care (MLTC) that are written in easy-to-understand language.  These educational materials were written alongside people who are covered by MLTC and their caregivers, as well as individuals who may need MLTC in the near future.  The members of the Workgroup assert that aspects of MLTC are not transparent enough and people need to learn more about their rights in simple language.  The Workgroup is comprised of New Yorkers with Medicare, Medicaid, and long-term care needs as well as their caregivers.

The three tip sheets are on who is eligible for MLTC, how to enroll, and on the rights of people on MLTC.

The Workgroup hopes these tip sheets help those who may be confused, concerned, or unaware of different aspects of MLTC, and that they help individuals better understand how to enroll in the MLTC plan that is best for them, as well as their rights once they are enrolled in a plan.

MLTC Report | July 2016

Mis-Managed Care: Fair Hearing Decisions on Medicaid Home Care Reductions by Managed Long Term Care Plans, June-December 2015

With the New York Chapter of the National Academy of Elder Law Attorneys, MMNY issued a report to shed light on the findings of an extensive study of fair hearing decisions on reductions of personal care and Consumer Directed Personal Assistance services hours by Managed Long Term Care (MLTC) plans.  The report makes specific policy recommendations to address the need for better oversight and monitoring of plan activities.

The report was featured in a story in the NYTimes on July 21, 2016.

See our press release on the report here.