25New York health coverage remains strong with around 4.3 million New Yorkers covered according to a report by the state Health Department. The same statement also noted the remarkable shift to more affordable plans this year. As the NY health department aims for security in health insurance and maximum protection for patients, it has recently transformed its Managed Long-Term Care (MLTC) program. The change is directed to MLTC eligibility where adults, who require community-based care for over 120 days, will be eligible for MLTC enrollment instead of fee-for-service delivery scheme.

The Past and Present of MLTC

The managed long-term care plan was developed in 2006 to help the state achieve its triple aim:

  • Better care experience
  • Better health outcomes
  • Lower health care costs

MLTC provided a comprehensive plan with benefits intended to eligible persons aged 18 years old and above. It further allowed enrollees to access a broader range of options when it comes to selecting their providers. MLTC plans also provided access to services like personal care, social services, and medical care. Mandatory enrollment was initiated in 2012 and is now being implemented in all counties in New York to give eligible residents the chance to benefit from a long-term care plan as an intervention to their medical conditions.

Recently, the constant evolution of MLTC incorporated a three-pronged approach.  Which includes:

  1. Integration and enhancement of services like primary and preventive care and incorporating Behavioral Health services for mental and substance use disorders
  2. Provision of quality incentives for the achievement of primary care delivery metrics
  3. The improved transition of care involving hospitals and community decreased adverse events and reduced instances of re-hospitalization

The MLTC Plus Program

Better access to primary health care leads to better health results. Enrollees who undergo regular visits to their doctors tend to receive health care services that prevent them from suffering future health issues. Moreover, they are also entitled to experience enhanced management of behavioral and chronic health conditions which eventually result in decreased chances of premature death. It is then a common understanding that re-hospitalization is a costly and life-threatening event which is a result of gaps between follow-up and primary health care.

This notion gave birth to the MLTC Plus Program that aims to strengthen the coordination between physicians and patients. The new program is seen to reduce the instances of readmissions and re-hospitalizations, with eligible enrollees ensured to receive medical assistance for continuous 120 days.

The Impacts of Transformation

As New York pushes for the limit of MLTC plans, patients who need coverage for more than 120 days are now required to revert to Medicaid. Effective April 1, 2018, the Enacted Budget stipulates that individuals will qualify for the program should they need to undergo community-based care for more than 120 days at a continuous period, and not aggregate phases. Thus, more patients may be subject to reduced access to hospital and medical facilities while those who qualify under the new plan may see the lowered cost and improved reimbursement scheme.

Meanwhile, managed care insurers need to comply with the new limits as restrictions are placed on licensed home care services. Private insurance providers should contract with 1,500 LHCSAs to provide in-home care to the disabled and elderly.

The changes are also tied up to the state’s DSRIP or Delivery System Reform Incentive Payment program to restructure the delivery system via investment in Medicaid program. It is viewed to promote value-based payments, enhance care transitions and integrate behavioral health services. In the next five years, the MLTC Plus is projected to reduce hospital use by 25%.

Considering the change, providers and insurers are left to understand that the move aims to further move the health care system to the right direction – improving the requirements for assessment, registration, and approval of licenses for LHCSAs. The NY Health Department is looking forward to further develop a more extensive connection between MLTC and DSRIP goals in the years to come.