NYS DOH Issues Medicaid Update

The New York State Department of Health’s June Medicaid Update notes that Medicaid beneficiaries who are enrolled into partial capitation MLTC plans will have a 90-day grace period to change plans before being subject to a nine-month “lock-in” period during which they may not transfer plans without demonstrating evidence of “good cause.” The DOH’s examples of “good cause” include the enrollee moving to a new service area, the failure of the plan to furnish services, or it is determined that the enrollment was non-consensual. This limitation on the ability of patients to change MLTC plans may prevent patients from changing MLTC plans to a plan that contracts with a LHCSA of their choice. The DOH also encouraged providers to monitor the eMedNY site for updates and to consider sending representatives to training sessions across the state.

If you have any questions about the moratorium, please contact any member of the Hodgson Russ Home Care team.