What an MLTC plan does
New York’s Department of Health describes Managed Long Term Care as the way the state delivers long-term services and supports to people who are chronically ill or disabled and want to stay in their homes. The plan is a state-approved managed care organization. It reviews your assessment, writes a plan of care, authorizes a number of hours and pays the agencies or aides who deliver the help.
The services it covers are what the state calls community based long term services and supports:
- nursing services and 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 Services, the program where you hire your own aide.
The most common confusion is treating MLTC as a kind of care. It is the payer. Someone “on MLTC” still receives agency personal care or CDPAP; the plan decides how much. The four kinds of Medicaid home care.
Who qualifies for MLTC in New York
Three conditions have to line up.
You have Medicaid. MLTC is a Medicaid benefit. For people 65 and older or applying on the basis of disability, the application goes through the local department of social services, which in New York City is the Human Resources Administration, not NY State of Health. If income is over the limit, the Excess Income program and a pooled income trust are the usual ways in. Legal Services NYC notes that the assessor will not schedule a standard assessment while a Medicaid application is still pending.
You need long-term help. You must be assessed as needing community long-term care for more than 120 days. A few weeks of nursing after a hospital stay is not this; that is short-term home health care, often paid by Medicare. How Medicare home health works.
You meet the minimum needs rule. For assessments from September 1, 2025, the state requires at least limited assistance with physical maneuvering with more than two activities of daily living, or, for someone with a dementia or Alzheimer’s diagnosis, at least supervision with more than one. Help only with housekeeping or shopping does not meet the need. People assessed before that date stay under the earlier “legacy” rules.
When enrollment is mandatory and when it is optional
| Your situation | MLTC enrollment |
|---|---|
| Medicare and Medicaid, age 21 or older, need community long-term care for more than 120 days, meet the minimum needs rule, live in New York State | Mandatory |
| Medicare and Medicaid, age 18 to 20, same need | Voluntary |
| Medicaid only, age 18 or older, same need | Voluntary |
| Fee-for-service Medicaid, services started through the local district | NY Medicaid Choice notifies you if and when enrollment becomes mandatory |
The three MLTC plan types
| MLTC partial capitation (MLTCP) | Medicaid Advantage Plus (MAP) | PACE | |
|---|---|---|---|
| Age | 18 and older | 18 and older | 55 and older |
| Coverage you need | Medicaid | Medicaid and Medicare Parts A and B | Medicaid; Medicare if you are eligible for it |
| What the plan covers | Community long-term care and related services, including up to 3 months of nursing home care | Long-term care plus primary, acute and behavioral health care and drugs, with an aligned Medicare dual special needs plan | All medically necessary care, primary, acute and long-term, through a PACE team |
| Your doctors and hospital | Stay with your Medicare or Medicaid coverage | Run through the plan’s network | Run through the PACE team and its providers |
| Extra condition | Minimum needs rule | Minimum needs rule; you join the plan’s aligned Medicare Advantage plan | Need nursing home level of care; able to live safely at home when you join |
Partial capitation handles the long-term care and leaves your doctors, hospital and prescriptions where they are, under Original Medicare or a Medicare Advantage plan. For someone who likes their current Medicare setup, that is the least disruptive option.
MAP puts everything under one organization: Medicare, Medicaid, long-term care and drug coverage. The trade is the network; your doctors and hospital have to be in it. How Medicare and Medicaid fit together.
PACE is the most integrated. A team of doctors, nurses, social workers and other professionals coordinates Medicare, Medicaid, long-term care and drug benefits under one plan. It suits people who already need a nursing home level of care and want to stay home, and it means using the program’s own providers.
The state publishes the current list of plans by county in its Managed Long-Term Care Plan Directory. We do not rank them; the deciding questions are whether a plan covers your borough, whether your home care agency or aide works with it, and, for MAP and PACE, whether your doctors are in it.
MLTC compared with the other long-term care routes
MLTC is the default route for long-term help at home in New York, but it is not the only one. Each alternative below has its own door, and choosing the wrong one costs weeks.
| Route | Who it fits | Who decides | Where to start |
|---|---|---|---|
| MLTC partial capitation, MAP or PACE | Medicaid, need for community care over 120 days, minimum needs rule | The plan, after the NYIA assessment | NYIA, 855-222-8350 |
| Assisted Living Program | Medically eligible for a nursing home, unsafe living alone, no continual nursing | The ALP’s assessment and the local district’s approval | The ALP itself |
| NHTD or TBI waiver | Seniors, adults with physical disabilities, or adults 18 to 64 with a brain injury, at nursing home level of care | The Regional Resource Development Center | The RRDC; NHTD was not taking new referrals in 2026 |
| Nursing home | Needs continual nursing care | Medicaid’s institutional rules, with a 60-month look-back | The facility and HRA |
Waiver participants are excluded from MLTC, so someone in the NHTD or TBI waiver does not also join an MLTC plan. Enrolling in MLTC does not trigger a transfer look-back today: a 30-month look-back for community care is in state law but, as of February 2026, had no start date. How the look-back works.
Married MLTC members: what the spouse at home keeps
Spousal impoverishment rules are usually described for nursing homes, but the Health Department’s 2026 notice to married couples applies them to anyone receiving services and enrolled in a Managed Long Term Care plan, when the other spouse is not. That changes the budget for many couples in New York City.
| 2026 figure | Amount |
|---|---|
| Resources the spouse at home keeps | At least $74,820, up to $162,660 |
| Monthly income allowance for the spouse at home | Up to $4,066.50 |
| Personal needs allowance for an MLTC member budgeted under spousal rules | $653 a month, per GIS 26 MA/05 |
| Special income standard for housing expenses, New York City | $2,104 a month, for certain MLTC enrollees, per the state’s 2026 chart |
The housing standard lets certain MLTC enrollees keep more of their income toward housing costs; the state’s directive limits who qualifies, so ask HRA whether it applies to your case. To get the spousal numbers calculated, request an assessment from HRA’s Medicaid Helpline at (888) 692-6116 or with form DOH-5298.
How enrollment works, step by step
- Make sure Medicaid is active. If the application is pending, follow up with HRA first. People with an urgent need who do not yet have services can ask HRA for an Immediate Need review; a complete Medicaid application is required.
- Call NYIA at 855-222-8350 (TTY 1-888-329-1541). You or an authorized representative on file with NYIA can call. Health plans and local districts refer people to the same number.
- Attend two appointments. A Community Health Assessment, which usually takes 2 to 3 hours, and a clinical appointment of up to an hour, where a clinician completes the practitioner order. Each can be in person or by video. Legal Services NYC says both should be scheduled and completed within 14 days of your call.
- Wait for the NYIA letter. It says whether you are eligible and what comes next. Legal Services NYC says the assessment and practitioner order are valid for 12 months.
- Choose a plan from the plans serving your county. Each plan reviews the assessment and develops its own plan of care; if it would authorize more than 12 hours a day, the plan sends the case back to NYIA for a further review.
- Sign the plan’s enrollment form. The plan submits it to NY Medicaid Choice. Paperwork processed around the 18th of a month decides which month coverage starts, so ask the plan for the start date in writing.
Your situation and what to do
| Your situation | What to do |
|---|---|
| You have Medicaid and need daily help that will last for months | Call NYIA at 855-222-8350 for an initial assessment |
| Your Medicaid application is still pending | Finish it with HRA first; ask about Immediate Need if care cannot wait |
| You want a family member to be your paid aide | Ask each plan you consider about CDPAP; a spouse usually cannot be paid |
| You need nursing visits for a few weeks after a hospital stay | That is short-term home health care, usually through Medicare, not MLTC |
| NYIA found you not eligible | Request a fair hearing within 60 days of the notice |
| Your plan cut your hours | Appeal, and ask for aid continuing within about 10 days to keep current hours meanwhile |
| You are unhappy with how a plan treats you | Call ICAN, the state’s free ombudsprogram, at (844) 614-8800 |
When the answer is no, or the hours are too low
An NYIA denial can be challenged with a state fair hearing, requested within 60 days of the notice date. A plan’s decision to reduce or deny hours goes first through the plan’s own appeal and then to a fair hearing. The deadline that matters most is the short one: to keep the current hours running while the appeal is decided, you ask for aid continuing within about 10 days, before the change takes effect.
Two free sources of help in New York City. ICAN, the Independent Consumer Advocacy Network, is the state-funded ombudsprogram for people with Medicaid who need long-term care, at (844) 614-8800. Legal Services NYC takes calls about NYIA denials and Immediate Need delays at 917-661-4500, weekdays from 9:30 a.m. to 4 p.m.
Getting to medical appointments is a separate Medicaid benefit, booked through the state’s transportation manager rather than the plan. How to book a free ride.
Questions people ask
What does MLTC mean?
Managed Long Term Care. It is a Medicaid plan that authorizes and pays for long-term help at home, such as personal care, home health aides, adult day health care and CDPAP, for people who need that help for more than 120 days.
Who is eligible for MLTC in New York?
People with Medicaid who are assessed as needing community long-term care for more than 120 days and who need at least limited hands-on help with more than two daily activities, or supervision with more than one if they have dementia or Alzheimer’s.
How do I apply for an MLTC plan in NYC?
With active Medicaid, call the New York Independent Assessor at 855-222-8350 to schedule the assessment. After you receive the eligibility letter, choose a plan that serves your borough and sign its enrollment form.
What is the difference between MLTC and PACE?
PACE is one of the three MLTC plan types. It is for people 55 and older who need a nursing home level of care, and it covers all medical and long-term care through a PACE team. A partial capitation MLTC plan covers only the long-term care.
Is CFEEC still used for MLTC?
New York now uses the New York Independent Assessor, NYIA, for the initial assessment. If an older letter or website tells you to call CFEEC, call NYIA at 855-222-8350 instead.
Is there a look-back for MLTC in New York?
Not in operation. A 30-month look-back for community-based care, including MLTC, was enacted in 2020, but it still needed federal approval and had no start date as of February 2026. The 60-month look-back applies to nursing home Medicaid.
Does my spouse lose our savings if I join an MLTC plan?
No. The state’s spousal impoverishment protections apply to MLTC enrollees. In 2026 the spouse at home keeps at least $74,820 and up to $162,660 in resources, and income up to $4,066.50 a month.
Can I get paid to care for my mother through MLTC?
Often, through CDPAP, which MLTC plans cover. Many relatives can be the paid aide, with exclusions by relationship; a spouse usually cannot. Ask the plan about your exact relationship before you rely on it.
Sources
- New York State Department of Health — Managed Long Term Care (MLTC) (checked 2026-10-29)
- New York State Department of Health — MLTC Partial Capitation (MLTCP) eligibility (checked 2026-10-29)
- New York State Department of Health — Medicaid Advantage Plus (MAP) (checked 2026-10-29)
- New York State Department of Health — Program of All-Inclusive Care for the Elderly (PACE) (checked 2026-10-29)
- New York State Department of Health — New York Independent Assessor Program FAQ (October 2025) (checked 2026-10-29)
- Legal Services NYC — How do I enroll in a managed long-term care (MLTC) plan? (checked 2026-10-29)
- Independent Consumer Advocacy Network (ICAN) (checked 2026-10-29)
- NYS Department of Health, Information notice to couples with an institutionalized spouse (2026) (checked 2026-11-03)
- NYS Department of Health, GIS 26 MA/05: 2026 federal poverty levels, personal needs allowance and housing standard (checked 2026-11-03)
- NYS Department of Health, GIS 26 MA/05 attachment: 2026 income and resource standards (checked 2026-11-03)
- NY Health Access, status of the 30-month lookback (updated February 2, 2026) (checked 2026-11-03)
More in Medicaid in New York: Who Qualifies, How to Apply, How to Keep It
- Brooklyn Medicaid Offices: Every HRA Location, What to Bring, and When to Skip the Trip — Brooklyn's HRA Medicaid offices and SNAP centers with addresses and hours from HRA, what to bring, and when NY State of Health or ACCESS HRA saves you the trip.
- Your New York Medicaid Card: The State Benefit Card, the Plan Card, and How to Replace Either One — The New York Medicaid card is a state Benefit Identification Card; your plan card is separate. Who to call to replace each in NYC, and when to show both.
- Medicaid for New Yorkers 65 and Older: Where to Apply, What It Adds to Medicare, and the Rules That Differ — Medicaid at 65 and older in New York City: apply through HRA, not NY State of Health. How it works with Medicare, savings programs, spend-down and home care.
This page explains how the system works. It is not medical advice. More.