The Covid-19 pandemic had a massive toll on nursing home patients and their family members, as they were unable to see their loved ones during such a difficult and uncertain time. The State Department of Health distributed notices concerning disenrollment from the MLTC plan on August 1st, 2020. An estimated 20,000 individuals will be receiving this notice, as they are MLTC members within New York State who have been in nursing homes for the last 3 months. The State Department of Health proceeded with a mass disenrollment of approximately 15,600 members of MLTC despite numerous attempts by advocates countering the distribution of the notices and the prospects of disenrollment. There is a very concerning quantity of upstate New Yorkers being placed directly into nursing homes, instead of having the opportunity to return home with the assistance of MLTC services. Another extensive disenrollment is expected to occur on November 1st, 2020. This means that MLTC members should expect disenrollment notices during the month of October. Those who have been in nursing homes for the past 3 months and have been approved for institutional Medicaid will be receiving these disenrollment notices. There will be information within these notices concerning individuals fair hearing rights. Those who have received the disenrollment notices are able to communicate with NY medicaid Choice where they will be given the chance to schedule for an assessment to be discharged home by the MLTC.
Upon receiving a notice from MLTC it is highly recommended that individuals should reach out to an esteemed attorney who has experience handling concerns with Medicaid. Some potential advocacy tips for individuals who have received notices pertains to placing a request for a fair hearing, as this assists in minimizing the chances of disenrollment. Additionally, an individual should call NY Medicaid Choice in order to put in a request for potential health care services or request an assessment by MLTC. It is important to note that an individual can re-enroll into the MLTC plan within the time frame of 6 months from being disenrolled. An esteemed attorney can be extremely beneficial in regards to re-enrollment without having to do a Conflict Free Evaluation. The CFEEC represents the Conflict-Free Evaluation and Enrollment Center, which is responsible for determining if an individual requires Medicaid based long term care. Keep in mind that MLTC enrollment takes place on the first day of the month, so it will be required for individuals to wait till the first day of the next month in order to re-enroll. Individuals who are a part of the Long Term Nursing Home Stay will not be included in enrollment of an MLTC plan. These individuals will be able to partake in an application for Immediate Need Personal Care services through the aid of an attorney in relation to the Medicaid program.
On September 17th, 2020 a revision in federal policy took place in regards to nursing home visitation. This change has produced a new requirement for nursing homes to allow visitors both within and outside of the facility. Based on the current Covid-19 pandemic there are many factors that could potentially have a direct impact on visitation accessibility. New York state policy states that the visitor should provide a negative Covid-19 test result prior to visiting a loved one in a facility. Counties with medium or high positivity rates would recommend regular testing of visitors. This is an extremely stressful time given the uncertainties with the pandemic and is becoming more stressful with the current restrictions on who is eligible for Long Term care and MLTC enrollment. Given the situation, it would be extremely helpful to request the aid of an experienced attorney who has worked with many instances of Medicaid circumstances. Approximately 15,600 members were disenrolled from their MLTC plans, while only 19 of these members requested a fair Medicaid hearing or called NY Medicaid Choice to request an assessment. With the aid of an experienced attorney more members can avoid disenrollment. For Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2394 to best prepare for the potential disenrollment from MLTC plans and to obtain guidance on which actions to take to produce the best result.