Who is required to enroll in an MLTC plan?

Individuals with Medicare and Medicaid needing long-term care are required to enroll in a Managed Long-Term Care (MLTC) plan. This requirement is in place because MLTC plans are specifically designed to provide comprehensive long-term care services for those who are eligible for both Medicare and Medicaid and need assistance with daily living activities. These plans help to coordinate care and ensure that individuals receive the medical and support services they require in a community-based setting, rather than in institutional care.

This population often includes elderly individuals, as well as younger people with disabilities, who have complex health needs that can benefit from the integrated approach provided by MLTC plans. Being enrolled in these plans allows for personalized care management, providing better outcomes and quality of life for participants.

The other options highlight specific groups that do not typically fall under the requirement for MLTC enrollment. For example, individuals needing less than four months of care or those under 21 years of age often have different needs and options for service delivery, while individuals living outside New York State are not eligible for MLTC plans, which are specific to the state's Medicaid program.