MLTC Insurance Plans | New York MTLC

Extra care to help you live independently in NY

Managed Long-Term Care (MLTC) provides services and support to NY Wellpoint members with long-lasting health problems or disabilities.

MLTC services include help with everyday tasks like bathing, dressing, getting around the house, making meals, or doing household chores. A designated care manager will help you find the services you need. They’ll do an in-home assessment, develop a personal care plan, and coordinate benefits with your other healthcare providers.

Pay my surplus (coming soon)

Who’s eligible for MLTC?

You may be eligible for MLTC through Wellpoint if you:

Are 18 or older.
Are eligible for Medicaid.
Live in Erie or Niagara County.
Have a chronic illness or disability that makes you clinically eligible for enrollment, based on an assessment.
Are expected to need at least one (1) of the following community-based long-term care services for more than 120 continuous days from the effective date of enrollment:
- Nursing services in the home
- Therapies in the home
- Home health aide services
- Personal care services in the home
- Adult day health care
- Private duty nursing
- Consumer Directed Personal Assistance Service (CDPAS)

Interested in becoming an MLTC member?

Call 877-388-5192 (TTY 711) to find out more about MLTC and how to enroll with Wellpoint.

What you get with Wellpoint

Covered services

When you join our plan, you keep all your current Medicaid benefits. Here is a partial list of Wellpoint MLTC benefits. These benefits are covered when you join our MLTC program, so you never have any copays. Benefits of Wellpoint MLTC coverage include:

Adult day health care
Audiology/hearing aids
Care management
Consumer Directed Personal Assistance Service (CDPAS)
Dentistry
Durable medical equipment
Home care
Home-delivered or congregate meals
Medical social services
Nursing home care (Residential Healthcare Facility)
Nutrition services
Occupational therapy
Optometry/eyeglasses
Personal care
Personal emergency response system
Physical therapy
Podiatry
Private duty nursing
Respiratory therapy
Social day care
Speech therapy
Social and environmental supports

Be sure to review the Wellpoint MLTC member handbook for a complete list of benefits. For some services, a doctor’s order and/or approval from Wellpoint may be required.

Respect for you and your choices

Consumer Directed Personal Assistance Service (CDPAS) provides in-home services for people who:

Are self-directing or have someone to make choices about their care.
Need community-based long-term care services.

Being a self-directing member means you or a person you choose are responsible for making decisions about and managing your CDPAS services. These services are provided through your MLTC plan.

Learn about CDPAS

Coordinated services

Coordinated services are services that aren’t covered by your Wellpoint MLTC plan. You get these services through Medicare or through fee-for-service Medicaid. Your care manager is here to assist you by arranging and coordinating services for you such as:

Hospitalization
Physician care
Specialist care
Lab tests
Prescription drugs
Behavioral health
Non-emergency medical transportation

Our care management team works to help make healthcare less complicated for our MLTC members. We manage all your physical, behavioral health, and long-term care services through care coordination. These services include:

Your care manager

You’ll have your own care manager who’ll get to know you, your family, and your care team. They will help you:

Access the right long-term care services in the right setting.
Receive the necessary medical supplies and equipment.
Find doctors and other resources close to home.
Make good healthcare choices.

Your care team

Your care team includes a care manager, doctors, family, and you. We’ll work together to help manage your health.

Your care plan

You’ll get a care plan designed just for you. Your care manager will work with you to decide what care and services are needed to meet your healthcare goals.

Your health plan support

Our team of experienced nurses and social workers know your community. They can help you decide on treatment options, find local resources, and learn how to get the most from your benefits.

Preapprovals

Some services need preapproval or prior authorization. This means you or your doctor must ask Wellpoint to approve those services or benefits before you get them. These services include: