Dec
1
2022

The Difference Between Medicaid Managed Long Term Care Plans (MLTC) & Commercial Long Term Care Plans

Posted in Senior Health Care Tips by

Medicaid Managed Long Term Care Plans (MLTC) are government funded through Medicaid.  Services are based on the client’s health and income.  The MLTCs are also known as Community Based Long Term Care. Only home care agencies contracted with Medicaid can bill MLTC Plans.

  1. The client must apply and be approved for Medicaid coverage
  2. If the client is receiving Medicaid services, then the Long Term Care Plan is a Medicaid MLTC Plan.
  3. The MLTC contracts with only approved Certified Home Health Agencies (CHHAs)
  4. Consumer Directed Personal Care Programs (CDPAP) are part of the Medicaid MLTC Plans.
  5. https://www.health.ny.gov/health_care/managed_care/mltc/
  6. https://www.health.ny.gov/health_care/medicaid/program/longterm/

SelectCare is not contracted with Medicaid and therefore unable to provide care to clients who have MLTC Plans.

Commercial Long Term Care (LTC) Plans are purchased privately with annual premiums paid by the client. If a client fails to pay the premium, the insurance coverage is cancelled.

  1. Most plans have an elimination period, a daily benefit amount and a specific monetary maximum benefit.
  2. Clients must prove their physical / mental health needs will last longer than the elimination period of the LTC.
  3. Most Commercial LTC Plans require home care services provided by Licensed Home Care Service Agencies (LHCSA).
  4. https://www.dfs.ny.gov/consumers/health_insurance/long_term_care_insurance/comparing_policies
  5. https://www.in.gov/idoi/files/Guide_to_Long_Term_Care_Insurance.pdf

SelectCare meets the provider requirements for most commercial long term care plans throughout the USA.

  1. SelectCare will confirm the LTC benefits in a joint telephone conversation with client and LTC representative to determine the specific requirements needed to activate the benefit.
  2. SelectCare submits bills to the commercial long term care plan and accepts direct payment in many cases.  Clients only receive a bill when the daily home care charges are more than the daily benefit and for home care service hours provided during the elimination period.