Managed Long Term Care is a plan you enroll in, not a service you receive. The plan assesses what help you need, authorizes a number of hours, and arranges and pays for the services. What you actually receive is personal care from an agency aide, or CDPAP from someone you hire yourself.

That distinction causes more confusion than any other term in this section. People say “I have MLTC” meaning “I have home care,” and then call the wrong number when something goes wrong.

In New York: MLTC is how the state generally arranges Medicaid long-term services for people who need help at home over months rather than weeks. Two practical consequences.

The assessment decides everything, so it is the step to prepare for rather than the step to get through. Describe a bad day rather than an average one, say what happens at night, and have the treating clinician’s documentation available.

And a plan’s decision to reduce or deny hours is appealable. The plan’s internal appeal usually comes first, then a state fair hearing. The deadline to keep your current hours running while it is decided is about 10 days, far shorter than the 60 days you have to appeal at all.

If your income is over the Medicaid limit, that does not block enrollment: a pooled income trust is the usual route.

Also called: MLTC, long term care plan. Full guide: Medicaid home care in New York.

More in Glossary of health coverage and billing terms

  • Dual eligible — Having Medicare and Medicaid at the same time, which covers premiums, cost sharing and the long-term care Medicare does not.
  • Parity (mental health parity) — The rule that a health plan may not make mental health and substance use care harder or costlier to get than comparable medical care.
  • Step therapy — The rule that you must try a cheaper drug first before the plan will cover the one you were prescribed.

This page explains how the system works. It is not medical advice. More.