Managed Long Term Care

Question: My mother has Community Medicaid and she lives in her own home.  Now the Managed Long Term Care provider, GuildNet, is leaving this area.  What are my options?  Will her hours of care be reduced?  Should I be worried?

Answer:  Once an individual is financially approved by the local Department of Social Services for Community Medicaid, he or she must enroll with a Managed Long Term Care Company (or “MLTC”).  The MLTC will send a nurse to the Medicaid recipient in order to evaluate and create a care plan.  The evaluation typically will result in an award of hours to the Medicaid recipient for a home health to come to the home and assist the recipient with activities of daily living.  The amount of hours can consist of a few hours per day or live-in care depending on the needs of the Medicaid recipient. If the Medicaid recipient is satisfied with the care plan, he or she could choses to enroll with the MLTC.  Recently, one of the MLTCs, GuildNet, announced that it will no longer service Long Island and sought permission from the Department of Health to drop all current Long Island enrollees effective June 1, 2017.  This has led many Long Island Medicaid recipients to panic due to the fear of having a gap in coverage.

Enrollees in GuildNet must enroll in another MLTC to continue coverage through the Medicaid program.  In order to start the process, the new MLTCs must be contacted and a new home evaluation must be set up.  Each MLTC that comes to the home will conduct an evaluation and propose a care plan that includes how many hours the Medicaid recipient would receive under their program.  The care plan does not need to match the care plan established by GuildNet.  For example, if the Medicaid recipient is currently receiving live-in care, the new MLTC might assess the Medicaid recipient and only offer 8 hours per day.  This is a concern for many Medicaid recipients as a decrease in hours could result in devastating consequences.

The good news is the Department of Health issued a statement stating that GuildNet must continue to provide the existing services until a smooth transfer can be completed to your new plan of choice.  In other words, if the Medicaid recipient has not found a new MLTC with an appropriate care plan, GuildNet must continue to provide services until the transition is in effect and cannot stop as of June 1, 2017.  However, with that said, current contracts with individual home care agencies are being dropped by GuildNet.  This means that as of June 1, 2017, the Medicaid recipient may be required to switch to a different home health aide.

During this stressful time, you should reach out to an elder law attorney in your area to discuss your individual situation and determine the best course of action in order to protect the Medicaid recipient’s interests and current plan of care.