MLTC plans in New York, explained simply

What Managed Long Term Care is, who has to join, the three plan types, and how to switch or appeal.

Updated November 5, 2026 · Reviewed by Ettrick M. Campbell, Esq.

If your parent has both Medicare and Medicaid and needs home care, they'll almost always get it through a Managed Long Term Care (MLTC) plan. The plan, not HRA, decides the hours and arranges the aides.

Who has to join

You generally need an MLTC plan if you:

  • have Medicaid (and usually Medicare too);
  • need home care or other long-term services for more than 120 days; and
  • meet the state's minimum needs test: hands-on help with more than two daily activities, or dementia/Alzheimer's with supervision for more than one. This test applies to people first assessed on or after September 1, 2025.

People already enrolled before the change keep the old rules while they stay continuously enrolled.

The three main plan types

Plan Who it's for What it covers
MLTC Partial Capitation Most people with Medicaid needing home care Home care and long-term services only. Your doctors stay on regular Medicare
Medicaid Advantage Plus (MAP) People with both Medicare and Medicaid One plan for Medicare and Medicaid, including home care
PACE Age 55+ who need nursing-home-level care All care, often through a PACE day center

Choosing a plan

  • Ask which home care agencies the plan uses, and whether your preferred aide works with one.
  • Ask whether the plan supports CDPAP (paid family caregiver).
  • Check that your doctors and hospital are in network (for MAP and PACE).
  • Ask about Caribbean-language support (Haitian Creole, for example) if needed.

Switching plans

You can usually change MLTC plans if you're unhappy. Enrollment forms submitted by the 18th of a month take effect the 1st of the next month.

If the plan cuts hours

  • Ask for the decision in writing.
  • File a plan appeal first, then ask for a fair hearing if the plan says no.
  • Ask for "aid continuing" right away (usually within 10 days of the notice) to keep current hours while you appeal.

General information, not legal advice. Based on NYS Department of Health MLTC Policy 25.04 (effective September 1, 2025) and Legal Services NYC guidance.

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