Managed Long-Term Care (MLTC), Medicaid Advantage Plus (MAP), and Programs of All-Inclusive Care for the Elderly (PACE)

Managed Long-Term Care (MLTC), Medicaid Advantage Plus (MAP), and Programs of All-Inclusive Care for the Elderly (PACE) are three programs available in New York State (NYS) that offer comprehensive health care and long-term services to eligible individuals. Each program caters to specific groups and needs, providing a range of benefits. In this article, we outline the key differences and benefits of MLTC, MAP, and PACE plans in NYS and how they cover traditional home health care services like Personal Care Aide (PCA) and Home Health Aide (HHA) services.

Managed Long-Term Care (MLTC)

Overview

MLTC plans are designed for Medicaid-eligible individuals who are 18 years or older and require long-term care services for more than 120 days. These plans focus on providing long-term care services such as personal care, home health care, adult day health care, and skilled nursing services.

Key Features

- Eligibility: You only need Medicaid to qualify.

- Services: Offers a variety of long-term care services, including personal care, home health care (PCA and HHA services), adult day health care, and skilled nursing services.

- Flexibility: You can keep your separate Medicare plan or stay with straight Medicaid or Medicare for primary care services.

- Provider Choice: Utilizes outside providers, allowing you to choose from different providers.

Medicaid Advantage Plus (MAP)

Overview

MAP is designed for Medicaid-eligible individuals who are 18 years or older and require long-term care services for more than 120 days. MAP plans integrate both Medicaid and Medicare benefits, providing a comprehensive range of services including primary care, acute care, hospital care, prescription drugs, and long-term care services.

Key Features

- Eligibility: You need both Medicaid and Medicare to qualify.

- Comprehensive Coverage: MAP plans provide coverage for both medical and long-term care services, including primary care, hospital care, prescription drugs, and traditional home health care services (PCA and HHA services).

- Plan Structure: All services are delivered within the MAP plan, and you must use the plan for everything.

Programs of All-Inclusive Care for the Elderly (PACE)

Overview

PACE is designed for individuals who are 55 years or older, require a nursing home level of care, and are eligible for both Medicare and Medicaid. PACE plans offer an integrated, comprehensive approach to medical, social, and long-term care services.

Key Features

- Eligibility: You need both Medicaid and Medicare to qualify.

- Holistic Care: Emphasizes coordinated care that addresses medical, social, and emotional needs, focusing on interdisciplinary team-based care.

- Community-Based: PACE requires all primary care to be delivered in PACE centers. However, other long-term care services such as traditional home health care services (PCA and HHA services), nursing, and physical therapy can be provided at home.

How to Schedule an Evaluation

To schedule an evaluation for long-term care services in either MLTC, MAP, or PACE programs, you can call NY Medicaid Choice at 1-855-222-8350. They can guide you through the process and help you determine which program is best suited for your needs.

Conclusion

Understanding the distinctions between MLTC, MAP, and PACE plans can help individuals and their families choose the best option for their long-term care needs. MLTC offers flexibility in choosing providers and keeping separate Medicare or Medicaid plans for primary care. MAP and PACE provide comprehensive coverage by integrating Medicaid and Medicare benefits, with MAP offering a single plan structure and PACE emphasizing holistic, community-based care. All three programs offer coverage for traditional home health care services such as PCA and HHA services. To learn more about these programs or schedule an evaluation, contact NY Medicaid Choice at 1-855-222-8350. Assessing your needs and exploring these options can lead to the best long-term care plan for you.

See a list of plans available in your area here.