What Is Managed Long Term Care (MLTC) in New York?
A complete plain-English guide to New York’s Managed Long Term Care program for 2026, including who must enroll, what services are covered, the three plan types, the 2025 Minimum Needs Requirement update, and how to enroll through NYIAP.
Talk to AllProWhat MLTC is and who it serves in New York.
Managed Long Term Care (MLTC) is New York State’s program for delivering Medicaid long-term services and supports to people who are chronically ill or disabled and want to remain in their homes and communities. Rather than paying providers directly for each service under fee-for-service Medicaid, the state contracts with managed care organizations (MCOs), pays them a monthly capitated rate, and the MCO arranges and pays for covered services including home care, adult day care, and CDPAP.
MLTC is mandatory in New York for dual-eligible adults, meaning those who have both Medicare and Medicaid, who are aged 21 and older and who need community-based long-term care services for 120 days or more. This applies statewide. If you or a family member meets these criteria and is not yet enrolled in an MLTC plan, enrollment is required before Medicaid will authorize home care or other long-term services through the fee-for-service system.
Partial MLTC, MAP, and PACE: the three types of New York MLTC plans.
Partial MLTC Plans (MLTCP)
- Manage only the Medicaid long-term care portion of benefits. Medicare benefits remain separate
- Mandatory enrollment for dual-eligible adults aged 21 and older. Voluntary enrollment is available for dual-eligible adults aged 18 through 20 who meet eligibility and Minimum Needs criteria
- Cover community-based long-term services including home care, adult day care, and CDPAP
- Cover the first three months of a long-term nursing home stay. After three months, the member is disenrolled to fee-for-service Medicaid if nursing home care continues
- 9-month lock-in applies after a 90-day grace period. Good Cause exceptions permit mid-lock-in switching
- Approximately 25 MLTC organizations are contracted statewide across all plan types in SFY 2025-26, per the DOH actuarial report. Plan availability varies by county
MAP and PACE Plans
- Medicaid Advantage Plus (MAP) manages both Medicare and Medicaid benefits. Members generally must use in-network providers for all services
- Programs of All-Inclusive Care for the Elderly (PACE) manage all Medicare and Medicaid benefits for adults 55 and older who are otherwise eligible for nursing home admission
- Both MAP and PACE retain nursing home coverage indefinitely, unlike Partial MLTC plans which cap at three months
- PACE includes an adult day center where members receive primary care and other services
- 10 PACE plans and 12 MAP plans operating in New York in 2026. PACE has no lock-in period
- PACE is exempt from the September 2025 Minimum Needs Requirement
Services covered by New York MLTC plans.
MLTC plans are required to cover community-based long-term services and supports (CBLTSS). Covered services include:
- Home health aide services for assistance with activities of daily living in the home
- Personal care services for non-medical assistance with bathing, dressing, and daily routines
- Consumer Directed Personal Assistance Program (CDPAP) for members who prefer to direct their own care
- Private duty nursing for medically eligible members requiring extended skilled nursing at home
- Adult day health care and social adult day care programs
- Nursing home care for the first three months under MLTCP plans (MAP and PACE cover nursing home stays indefinitely)
- Home modifications, personal emergency response systems, and medical transportation as specified in the member’s plan of care
The MLTC enrollment process in New York.
Call NY Medicaid Choice to Request an NYIAP Assessment
Anyone seeking enrollment in an MLTC plan must first call NY Medicaid Choice at 1-855-222-8350 to request an NYIAP assessment. NY Medicaid Choice will refer the request to the New York Independent Assessor Program (NYIAP), which schedules a two-part assessment: a Community Health Assessment (CHA) conducted by a registered nurse, and a clinical appointment with a clinician on the Independent Practitioner Panel (IPP) who issues a Practitioner Order. Both appointments must be completed within 14 days of contact.
Complete the Assessment
The NYIAP nurse will assess the individual’s functional needs using the UAS-NY tool and determine eligibility for MLTC enrollment. As of September 1, 2025, eligibility requires limited assistance with three or more ADLs, or supervision with two or more ADLs with a documented Alzheimer’s or dementia diagnosis, in addition to needing care for 120 or more days. NYIAP sends written notice of eligibility determination. The assessment and practitioner’s order are valid for 12 months.
Choose a Plan
After receiving NYIAP’s approval notice, the individual has 75 days to choose an MLTC plan. After 75 days the assessment expires and a new NYIAP visit must be scheduled. To compare available plans by county, visit nymedicaidchoice.com or call NY Medicaid Choice at 1-888-401-6582. If the individual does not choose a plan within the window, one will be assigned.
Enroll and Begin Services
The chosen plan submits enrollment paperwork to NY Medicaid Choice/Maximus. If paperwork is submitted by the 18th of the month, enrollment is effective the first of the following month. The plan then develops a person-centered plan of care and authorizes services. Effective January 1, 2026, plans must decide standard service authorizations within 7 calendar days under the CMS Interoperability and Prior Authorization Final Rule. Expedited decisions remain at 72 hours.
MLTC questions for New York families and administrators.
Who must enroll in MLTC in New York?
MLTC enrollment is mandatory for dual-eligible adults aged 21 and older who have both Medicare and Medicaid and need community-based long-term care services for 120 or more days. This applies statewide. Individuals who receive services through the NHTD Waiver, TBI Waiver, or OPWDD HCBS waiver are excluded from mandatory MLTC enrollment.
What is the difference between Partial MLTC, MAP, and PACE?
Partial MLTC plans manage only the Medicaid long-term care portion of benefits while Medicare remains separate. MAP plans manage both Medicare and Medicaid and use an in-network provider model. PACE plans manage all Medicare and Medicaid benefits for adults 55 and older who would otherwise be eligible for nursing home admission and operate through adult day centers.
What changed with the September 2025 Minimum Needs Requirement?
Effective September 1, 2025, individuals enrolling in MLTCP or MAP must demonstrate limited assistance with three or more activities of daily living, or supervision with two or more ADLs with a documented Alzheimer’s or dementia diagnosis. Individuals enrolled before this date retain Legacy Status while continuously enrolled. PACE plans are exempt from this requirement.
How does MLTC affect LHCSAs in New York?
Most Medicaid-funded home care in New York flows through MLTC plans. LHCSAs must contract with MLTC plans to receive Medicaid reimbursement for most consumers. MLTC plans have network adequacy requirements but can terminate LHCSA contracts under specific circumstances. AllPro supports LHCSAs navigating MLTC contracting compliance through its consulting services.
AllPro supports LHCSAs navigating MLTC in New York.
Questions about MLTC or home care in New York?
AllPro’s nurse-led team works with families and LHCSAs across New York. Contact us with any questions about MLTC or home care navigation.
Contact Us