MLTC stands for Managed Long Term Care, a program in New York State that coordinates home-based services and supports for people who are chronically ill or disabled. Instead of piecing together care from multiple agencies, an MLTC plan acts as a single point of contact, arranging everything from home health aides to medical equipment so that members can continue living at home rather than moving into a nursing facility.
How MLTC Works
An MLTC plan operates like a managed care organization, but it focuses specifically on long-term services rather than standard medical care. The plan receives a set monthly payment from Medicaid for each member (called “partial capitation”) and uses that funding to arrange and pay for the services each person needs. Your regular doctor visits, prescriptions, and hospital stays are still covered separately through standard Medicaid on a fee-for-service basis. The MLTC plan handles the long-term care side of things: home care, personal assistance, therapy, transportation, and similar supports.
Every member is assigned a care manager who develops a personalized care plan, coordinates services, and adjusts things as your needs change over time.
Services Covered by MLTC Plans
All MLTC plans are required to arrange and pay for a broad set of services, as long as they’re medically necessary. These include:
- Home care: nursing visits, home health aides, and in-home occupational, physical, and speech therapy
- Personal care: help with bathing, dressing, eating, and other daily activities
- Adult day health care and social day care
- Home-delivered meals or meals at a group setting like a day center
- Medical equipment such as wheelchairs, hospital beds, and oxygen supplies
- Non-emergency transportation to medically necessary appointments
- Dental, vision, and hearing services, including eyeglasses and hearing aids
- Podiatry (foot care)
- Personal emergency response systems
- Home modifications and chore services to make your living space safer and more accessible
- Nursing home care if community-based services are no longer sufficient
Three Types of MLTC Plans
New York offers three categories of MLTC plans, each covering a different scope of services:
MLTC Partial Capitation is the most common type. It covers only long-term care services. Your primary care, specialist visits, and hospital stays remain under regular Medicaid. You must be 18 or older (21 or older for some plans) to enroll.
Medicaid Advantage Plus (MAP) bundles both Medicaid and Medicare benefits into a single plan. That means long-term care services plus your doctor visits, hospital stays, and prescriptions are all managed through one organization. You need to be 18 or older and enrolled in both Medicaid and Medicare.
PACE (Program of All-Inclusive Care for the Elderly) is the most comprehensive option. It covers everything MAP does, plus additional services like inpatient hospital care, specialty doctors, lab work, prescriptions, dialysis, emergency transportation, and mental health and substance abuse treatment. PACE is available to people 55 and older and typically centers around an adult day health center where members receive most of their care.
Who Qualifies for MLTC
To enroll in an MLTC plan, you need to meet both financial and functional criteria. On the financial side, MLTC is a Medicaid-funded program, so you must be eligible for Medicaid. For long-term care specifically, the income limit in most states is 300% of the Supplemental Security Income level, which comes to $2,901 per month for an individual in 2025. Most states also cap countable assets at $2,000 per person, though your primary home is generally exempt up to $730,000 in equity in most states.
On the functional side, you need to require the level of care that would typically be provided in a nursing facility. This generally means you need significant help with daily activities like bathing, dressing, eating, toileting, or moving around. The specific determination is made through a formal assessment.
The Enrollment Process
Enrollment starts with an independent health assessment conducted through the New York Independent Assessor Program. You or a family member can call their toll-free helpline at 855-222-8350 to schedule an evaluation. The assessment can be done in person or by video, and it has two parts: a community health assessment that typically takes two to three hours and a clinical appointment that takes up to one hour.
The independent assessor determines whether you meet the functional criteria for MLTC enrollment. This evaluation is deliberately separated from the MLTC plans themselves to avoid conflicts of interest. Neither the plan nor your local social services department performs an additional initial assessment after the independent assessor completes theirs, though they can flag discrepancies through a formal variance process.
Once you’re approved, you choose an MLTC plan that operates in your area. The New York State Department of Health maintains a directory of plans organized by county.
Switching Plans and Lock-In Rules
After you enroll in a partial capitation MLTC plan, you have a 90-day grace period during which you can switch to a different MLTC plan for any reason. If you don’t switch during those first 90 days, you’re locked into your plan for the following nine months. After that lock-in period ends, you can transfer freely again, but enrolling in a new plan restarts the cycle: another 90-day grace period followed by another nine-month lock-in.
If you need to switch during the lock-in period, you have to demonstrate “good cause.” Valid reasons include the plan failing to provide services outlined in your care plan, moving out of the plan’s service area, being enrolled without your consent, or your home care provider not having a contract with your current plan.
These lock-in rules apply only to the partial capitation plans for dual-eligible members age 21 and older. They don’t apply to MAP, PACE, or members under 21. You’re also free to leave an MLTC partial capitation plan entirely at any time to join an integrated plan, a mainstream Medicaid managed care plan, or return to fee-for-service Medicaid.
How MLTC Differs From Regular Medicaid Managed Care
Standard Medicaid managed care (sometimes called a “Partnership Plan” in New York) covers your primary care, specialists, hospital visits, and limited long-term care and behavioral health. It’s designed for general health coverage. MLTC is essentially the opposite focus: it covers long-term services and supports comprehensively but carves out acute and primary care to regular Medicaid.
This split means that if you’re in a partial capitation MLTC plan, you’ll carry two forms of coverage simultaneously. Your MLTC plan handles home care, personal assistance, equipment, and related supports, while standard Medicaid covers your doctor visits and hospital stays. The integrated options, MAP and PACE, eliminate this split by combining everything under one plan, which can simplify things considerably if you qualify.