New York MLTC: 2026 Senior Guide to Managed Long Term Care

Managed Long Term Care (MLTC) is the chassis through which roughly 280,000 to 300,000 New Yorkers receive Medicaid long-term services and supports. If you are 21 or older, dual-eligible for Medicare and Medicaid, and need community-based care for 120 or more days, MLTC is mandatory in all 62 New York counties. There are three currently-operating product types (MLTCP, MAP, and PACE), one discontinued (FIDA), and a stack of 2025 and 2026 changes that make this one of the most-misreported corners of New York Medicaid.

This guide walks through what MLTC is, the three products, the September 1, 2025 minimum-needs rule, how the NYIAP three-stage assessment works, lock-in and plan switching, what happens if you enter a nursing home, prior-authorization clocks, your three-layer appeal rights, the pending repeal bill, and where to get free help.

By Brevy Care Team · Last verified May 7, 2026

What Is Managed Long Term Care

MLTC is a managed-care program that delivers Medicaid long-term services and supports (LTSS) through capitated plans rather than fee-for-service. The state pays a per-member, per-month rate, and the plan is responsible for assessing the member, building a care plan, contracting with providers (home health agencies, fiscal intermediaries, adult day programs, assisted-living programs, short-stay nursing facilities), and managing the dollars.

Authority: PHL § 4403-f and the 1115 MRT Demonstration

MLTC sits on a layered legal stack. NY Public Health Law § 4403-f is the state authorizing statute. Operational rules live at 10 NYCRR Part 98 Subpart 98-1 (certificate-of-authority issuance, financial solvency, network adequacy, QARR quality measures, grievance procedures). Federal substrate is 42 USC § 1396u-2 and 42 CFR Part 438 (managed-care principles, actuarial soundness at § 438.4, service authorization at § 438.210, grievance and appeal rights at § 438.402). The mandatory-enrollment piece is authorized through the federal 1115 Medicaid Redesign Team Demonstration (CMS ID 11-W-00114/2; current renewal approved March 23, 2022 through March 31, 2027). The renewal package is due to CMS by approximately March 31, 2026. As of May 2026, NYSDOH had not yet posted a final renewal package on the public 1115 page.

Who Must Enroll

Under PHL § 4403-f(7), MLTC is mandatory for dual eligibles age 21 or older in all 62 New York counties who need community-based LTSS for 120 or more days. The 120-day threshold is the operative trigger: if your assessment indicates you need long-term help and you are dual-eligible, you have to choose an MLTC plan rather than receiving services through fee-for-service Medicaid.

Statutory Exclusions

PHL § 4403-f(7)(f) carves out specific populations:

• OPWDD-certified residents and individuals receiving OPWDD services
• Residents of an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
• People with primary mental-health diagnoses eligible for the Health and Recovery Plan (HARP) track
• Certain immigration statuses

If you fall into one of these groups, you are not steered into MLTC even if you otherwise meet the 120-day threshold.

What MLTC Covers (and What It Does Not)

MLTCP plans cover Personal Care Services under 18 NYCRR § 505.14, the Consumer Directed Personal Assistance Program (CDPAP) under 18 NYCRR § 505.28, home health aide services, adult day health, Assisted Living Program (ALP) services, short-stay nursing-facility care, durable medical equipment, non-emergency medical transportation, and a defined set of supplemental services. MLTCP plans do NOT cover Medicare A/B/D or Medicaid acute, primary, hospital, or specialty services. Members keep their original Medicare or a separate Medicare Advantage plan for those needs.

MAP plans cover everything an MLTCP covers PLUS Medicare A/B/D and Medicaid acute, primary, hospital, behavioral, and specialty services, all under one capitated plan with one ID card. PACE plans cover everything plus day-center primary care, meals, transportation, and caregiver support, with the day-center as the operational hub.

The Three Active Product Lines

The single most-confused area of New York MLTC writing is the distinction among the three product types. Treat the table below as load-bearing.

MLTCP (Partial Capitation)

MLTCP is the high-volume product. The state contracts with the plan for Medicaid LTSS only. The member keeps their original Medicare or an independent Medicare Advantage plan. Major MLTCP carriers in 2026 include VNS Health, Elderplan, AgeWell New York, Healthfirst, Senior Whole Health under Molina, ArchCare Community Life, Anthem HealthPlus, RiverSpring, ElderServe, Centers Plan members absorbed by Anthem effective January 1, 2026, and several smaller regional plans. Plan rosters consolidate frequently. Always verify against the current NYSDOH MLTC Plan Directory before recommending a specific plan to a senior.

Under PHL § 4403-f(7-a), MLTCP plans cover the first 3 months of a Long-Term Nursing Home Stay (LTNHS) designation and then disenroll the member to fee-for-service Medicaid. This rule does not apply to MAP or PACE.

MAP / FIDE-SNP (Medicaid Advantage Plus)

MAP plans are Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) under 42 CFR 422.2 with a State Medicaid Agency Contract (SMAC) executed under 42 CFR 422.107. Federal Exclusively Aligned Enrollment (EAE) under 42 CFR 422.514(h) has been mandatory since January 1, 2025: every MAP member must also be enrolled in the same parent organization's MLTCP plan. New York's MAP-MLTCP alignment pre-dates the federal mandate, so the 2025 federal change is largely a non-event for New York operations.

Major MAP carriers in 2026 include Wellcare Fidelis Dual Align (largest enrollment, statewide footprint, H3328 contract), VNS Health Total in Better Health (CMS 5-star rated in 2025; 13 counties; H5549 contract), Elderplan Plus Long-Term Care under MJHS (NYC five boroughs plus Nassau, Suffolk, Westchester, parts of the Hudson Valley; H3347 contract), Anthem HealthPlus Full Dual Advantage LTSS (absorbed Centers Plan MAP members effective January 1, 2026 following Anthem's October 2024 acquisition; H6510 contract), and Senior Whole Health of New York MAP under Molina Healthcare (H5599 contract). Several smaller plans are listed in older directories with uncertain 2026 status. Verify with HIICAP / NY Medicare Help (1-800-701-0501) before recommending.

PACE (Programs of All-Inclusive Care for the Elderly)

PACE is the most fully integrated product and the only one with a permanent statutory home. SSA § 1894 / 42 USC § 1395eee (Medicare PACE) and SSA § 1934 / 42 USC § 1396u-4 (Medicaid PACE) are permanent authorizations. Federal regulations sit at 42 CFR Part 460. Because PACE is not 1115-dependent, PACE survives intact regardless of MRT renewal outcomes.

PACE eligibility requires age 55+, residence in the PACE service area, a Nursing Facility Level of Care (NF-LOC) certification, and the ability to live safely in the community with PACE support. PACE is exempt from the September 1, 2025 minimum-needs ADL floor. This makes PACE the practical integrated-care route in 2026 for seniors who clear NF-LOC but might not clear the 3-ADL floor.

New York operates 10 PACE programs with approximately 10,500 enrollees. Active programs include ArchCare Senior Life (NYC plus Westchester), CenterLight Healthcare (NYC plus Westchester plus Nassau, the largest single PACE plan census in NY), Catholic Health LIFE (Western NY / Buffalo), Fallon Health Weinberg PACE (Western NY / Erie), Complete SeniorCare (Capital Region), Total Senior Care (Western NY rural), ElderONE / Rochester Regional Health (Monroe plus 6 surrounding counties), Eddy SeniorCare / St. Peter's (Capital Region), and PACE at Hudson Headwaters (opened February 1, 2025). Note: LiveOn NY is an advocacy organization, not a PACE provider, and PACE CNY closed in 2023, despite still appearing in older directories.

FIDA: Discontinued, and Why the 2025 FAI Sunset Does Not Affect NY

The Fully Integrated Duals Advantage (FIDA) demonstration operated from January 1, 2015 through December 31, 2019 under the federal Financial Alignment Initiative (FAI) Medicare-Medicaid Plan (MMP) authority. CMS and NY did not renew. The state pivoted to MAP plans (the FIDE-SNP architecture) starting January 1, 2020 as the post-FIDA integrated structure. Trade press routinely cites the December 31, 2025 FAI MMP nationwide termination (per the CY2023 Medicare Advantage Final Rule, 87 FR 27704, May 9, 2022) as if it affects NY MAP members. It does not. New York exited FAI six years earlier when FIDA closed. NY MAP plans operate under standard FIDE-SNP authority, not the FAI demonstration framework.

The FIDA-IDD program (for Individuals with Intellectual and Developmental Disabilities) remains active under separate CMS Financial Alignment authority and serves a distinct OPWDD-overlap population. Do not conflate it with the discontinued general FIDA.

The September 1, 2025 Minimum Needs Requirement

This is the most consequential MLTCP / MAP eligibility change of the last decade and the single most-cited regulatory development in 2025 to 2026 New York home-care commentary.

The New ADL Floor

Under MLTC Policy 25.04 (issued June 30, 2025; revised August 22, 2025) and 25 OHIP/ADM-03, new MLTCP and MAP enrollees on or after September 1, 2025 must demonstrate one of the following:

• Limited assistance with 3 or more Activities of Daily Living (ADLs), OR
• Supervisory assistance with 2 or more ADLs IF a documented Alzheimer's or dementia diagnosis is on file.

ADLs for this purpose are the standard six: bathing, dressing, toileting, transferring, eating, and continence. Limited assistance means hands-on help. Supervisory assistance means cueing, reminding, or stand-by support.

PACE Is Exempt

PACE eligibility continues to use the NF-LOC test only. This is the operative integrated-care route in 2026 for seniors who clear NF-LOC but do not clear the 3-ADL or 2-ADL-with-dementia floor.

Legacy Status for Pre-September 1, 2025 Enrollees

Pre-September 1, 2025 enrollees retain Legacy Status as long as they remain continuously enrolled in their MLTCP or MAP plan. If a Legacy member voluntarily disenrolls (for example, switches plans outside Good Cause with a coverage gap, or relocates out of state and returns) and tries to re-enroll later, they face the new floor. Legacy Status is a powerful protection but is fragile to enrollment gaps. Do not let coverage lapse.

What to Do If You Do Not Clear the Floor

• PACE (where age 55+ and within a service area).
• The 1915(c) waivers: NHTD (with the August 2024 enrollment freeze still in place), TBI, OPWDD, Children's.
• 1915(k) Community First Choice Option (an entitlement that layers on top of waiver services).
• Traditional Community Medicaid + private-pay home care.
• Pooled-trust-only Community Medicaid without LTSS, where the goal is acute and prescription coverage only.

How You Get Enrolled: NYIAP and NY Medicaid Choice

For any new MLTCP or MAP enrollee, the NY Independent Assessor Program (NYIAP) under 22 OHIP/ADM-01 is the operative clinical gatekeeper.

Stage 1: Community Health Assessment (CHA)

A NYIAP-employed RN visits the applicant in their home (telehealth permitted in some circumstances) and conducts a full ADL, IADL, cognitive, medical, and psychosocial assessment using the UAS-NY (Universal Assessment System for New York) instrument. The CHA score quantifies functional need and feeds the IPP review.

Stage 2: Independent Practitioner Panel (IPP)

A NYIAP-employed clinician panel (typically a physician or NP) reviews the CHA and medical records and issues a practitioner order documenting whether the applicant clinically requires MLTC services and at what intensity. For post-September 1, 2025 applicants, the IPP must affirmatively document that the applicant meets the 3-ADL or 2-ADL-with-dementia floor under MLTC Policy 25.04.

Stage 3: Independent Review Panel (IRP)

The IRP is triggered by cases averaging 12 or more hours per day of personal care or CDPAS hours, OR any live-in case (24-hour care arrangement). An additional independent clinical panel reviews high-hour cases for clinical justification. The IRP is a medical-necessity review, NOT a service-hour cap. No statewide 60-hour weekly cap exists in any NYSDOH directive, statute, or regulation. Plans (MLTCP / MAP) ultimately authorize hours, but the IRP review is a structural check.

NY Medicaid Choice and the Structural Conflict-of-Interest Concern

NY Medicaid Choice (NYMC), the enrollment broker, takes calls at 1-855-222-8350. NYMC walks the senior through MLTCP, MAP, and PACE plan options and processes plan selection. NYMC is NOT an ombudsman.

Maximus operates BOTH NYMC and NYIAP. The same private vendor that decides whether an applicant clinically qualifies for services is also the entity that brokers their enrollment into specific plans. Consumer advocates, including ICAN, have repeatedly flagged this. The federal ombudsman function for Medicaid managed-care members is therefore intentionally located outside Maximus.

ICAN: Your Independent Ombudsman

ICAN (Independent Consumer Advocacy Network) at 1-844-614-8800 is operated by the Community Service Society of New York and is structurally independent of Maximus. ICAN is the right first call when something goes wrong with an assessment, plan denial, or enrollment broker interaction. ICAN counselors do not charge for assistance.

Lock-in, Plan Switching, and Good Cause

Lock-in is one of the most-misreported areas in NY MLTC writing. Older trade-press summaries cite "MLTC Policy 21.02" as the lock-in authority. The operative policy is 21.04, not 21.02.

The Framework (MLTC Policy 21.04)

• 90-day grace period after enrollment. The member can switch plans freely during this window. The grace runs from the effective date of enrollment.
• 9-month lock-in following the grace period. The member is generally locked into the chosen plan for nine months.
• Good Cause exceptions allow plan switching during the lock-in. Categories include plan-quality issues, documented network-adequacy failures, the member relocates outside the service area, the member's primary provider leaves the plan network, the plan repeatedly fails to authorize medically necessary services, documented harm, and certain provider-relationship continuity claims.
• After the 9-month lock-in expires, the member returns to monthly switch flexibility.
• PACE has no lock-in. PACE members can disenroll at any time.

How to Switch Plans

Once a member selects a new plan through NY Medicaid Choice, the switch is effective the first of the following month, with the standard cutoff falling around the 18th to 20th of the prior month. Call NY Medicaid Choice at 1-855-222-8350 to initiate.

Plan Exits and Involuntary Disenrollment

Plan-driven involuntary disenrollment is governed by 10 NYCRR Part 98 grievance procedures and 18 NYCRR Part 358 fair-hearing protections. A plan may seek to involuntarily disenroll a member only on enumerated grounds (loss of Medicaid eligibility, move out of service area, certain documented behavioral issues). The member has full Mayer v. Wing notice rights and the right to a fair hearing with Aid Continuing. MLTC Policy 26.01 (effective approximately June 1, 2026) standardizes involuntary disenrollment notices and timelines.

What Happens If You Enter a Nursing Home: The Long-Stay Rule

This is one of the most operationally important and most-confused rules in NY MLTC.

The MLTCP Rule (PHL § 4403-f(7-a))

When an MLTCP member is designated for a Long-Term Nursing Home Stay (LTNHS), the MLTCP plan covers the first 3 months following the LTNHS effective date and then disenrolls the member to fee-for-service Medicaid. After disenrollment, FFS Medicaid pays the nursing facility directly under the standard institutional Medicaid framework.

The MAP and PACE Distinction

The 3-month rule does NOT apply to MAP or PACE. MAP plans cover full long-stay nursing-facility placement. PACE plans cover full long-stay placement. This is one of the highest-leverage practical distinctions for families weighing MLTCP vs. MAP at the moment of nursing-home admission. Staying with MLTCP means transitioning to FFS Medicaid after 90 days. Choosing MAP or PACE preserves the integrated-plan relationship indefinitely.

Practical Walkthrough

1. Member enters NF. Plan covers short-stay placement (rehab, post-acute) under standard MLTCP NF benefit.
2. Member crosses 90-day threshold or facility documents non-rehab status. Plan and facility coordinate on the LTNHS designation.
3. LTNHS effective date triggers the 3-month clock. Plan continues capitated payment for three months.
4. At 3 months, plan disenrolls to FFS Medicaid. Nursing-home bills are now paid directly by Medicaid FFS rather than through the MLTCP plan.
5. Patient pay (NAMI) calculation kicks in. Under 18 NYCRR § 360-4.6 and 42 CFR § 435.725, the member retains a $50 personal needs allowance and pays the rest of monthly income (less spousal allowances, health insurance premiums, court-ordered support, dependent allowances, limited home maintenance, incurred medical) to the facility.

The 60-month institutional lookback under 42 USC § 1396p(c)(1)(B) is fully active for nursing-facility Medicaid. Any asset transfers within 60 months of nursing-home placement remain reviewable.

Practical Advice for Families

• If the senior is in MLTCP and a long-term placement looks likely, consider whether a switch to MAP or PACE before the LTNHS designation could preserve integrated-plan continuity.
• Once disenrolled to FFS Medicaid, the member is no longer subject to MLTCP plan utilization-management decisions, but is also no longer protected by the plan's care-coordination infrastructure.
• Engage a Medicaid-planning attorney early if asset-transfer timing matters.

Service Authorization and the New 2026 Prior-Authorization Clocks

Plan-level utilization management is governed by 42 CFR § 438.210. Services and prior-authorization decisions must be made within standardized timeframes. Written notice of any adverse benefit determination must comply with 42 CFR § 438.404.

The New Clocks (Effective January 1, 2026)

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) applies to Medicaid managed-care plans for rating periods beginning January 1, 2026:

• Standard prior-authorization decisions: reduced from 14 days to 7 calendar days.
• Expedited prior-authorization decisions: 72 hours (unchanged).

These clocks apply to MLTCP and MAP plans. PACE plans operate under 42 CFR Part 460 with its own service-authorization framework.

How to Read an Adverse Benefit Determination Notice

If your plan denies, reduces, suspends, or terminates a service, you receive an adverse benefit determination notice. Read it against the standard set by Mayer v. Wing, 922 F. Supp. 902 (S.D.N.Y. 1996), the controlling NY notice-adequacy precedent. A defective notice (failing to specify the legal basis, the factual basis, the precise services affected, or the appeal rights) is grounds for the Administrative Law Judge (ALJ) to vacate the determination on procedural grounds before reaching the merits. NY ALJs routinely vacate plan determinations on Mayer v. Wing grounds. Read the notice carefully.

Your Three-Layer Appeal Rights

NY MLTC members have access to three layers of appeal, plus structural protections under federal due process and Mayer v. Wing notice precedent.

Layer 1: Plan Internal Appeal

• Federal authority: 42 CFR § 438.402.
• Filing window: 60 calendar days from the adverse benefit determination notice.
• Decision timeline: Standard 30 days, expedited 72 hours.
• Direct fair-hearing path: Per the FY 2017 New York budget reform, a NY Medicaid managed-care member is permitted to request a State Fair Hearing directly without first exhausting the plan internal appeal. Many other states require exhaustion. New York does not.
• Aid Continuing: Available if the appeal is filed before the effective date of the action OR within 10 days of notice (per 18 NYCRR § 358-3.6). Aid Continuing keeps existing services in place pending the appeal.

Layer 2: External Review (PHL § 4914)

An independent review organization (IRO) reviews medical-necessity disputes after plan internal appeal. Filing window: 4 months from the plan's final adverse determination. Most powerful for medical-necessity disputes where the question is whether a service is clinically required (level of personal-care hours, equipment, specialized therapies).

Layer 3: State Fair Hearing (18 NYCRR Part 358)

• Filing channel: NY State OTDA Office of Administrative Hearings, 1-800-342-3334.
• Filing window: 60 days from the adverse action (or 60 days from the plan's final internal-appeal decision, whichever is later).
• Aid Continuing: Request before effective date OR within 10 days of notice. § 358-3.6 controls.
• Hearing structure: ALJ hears testimony from the member, the plan representative (often a clinical reviewer), and any expert witnesses. Decisions are issued in writing typically within 90 days.

MAP Appeals Bifurcation Effective January 1, 2026

For MAP plan-level appeals on services requested on or after January 1, 2026, the unified Applicable Integrated Plan (AIP) external appeal / fair-hearing pathway no longer applies:

• Medicaid-side denials → OTDA Fair Hearing within 60 days.
• Medicare-side denials → Standard Medicare appeals: Livanta QIO for hospital and SNF denials, Maximus IRE for other Part C services.
• Legacy IAHO integrated pathway remains available only for services requested before January 1, 2026, with all integrated appeal requests due no later than April 19, 2026.

The Medicare Rights Center (1-888-466-9050) and HIICAP / NY Medicare Help (1-800-701-0501) consistently flag the bifurcation as the single most disruptive 2026 NY MAP operational change.

Engesser v. McDonald and CDPAP / PPL Coordination

Engesser v. McDonald, EDNY 1:25-cv-01689 (Hon. Frederic Block), reached final settlement approval on October 3, 2025 (ECF No. 140) and established protections for consumers and personal assistants affected by the April 1, 2025 PPL transition. Indirect MLTC effects flow through CDPAP coordination duties imposed on plans during the PPL transition. NYLAG was lead counsel.

The Pending Home Care Savings & Reinvestment Act

This is one of the highest-citation-potential and most-misreported items in New York home-care commentary.

What S2332-A / A6346-A Would Do

NY Senate S2332-A (sponsor: Senator Rivera) and the companion A6346-A in the Assembly would repeal the MLTC Partial Capitation product line entirely and transition home-care services back to fee-for-service Medicaid (or an alternative chassis to be determined). The bills represent sustained advocacy by labor and consumer groups concerned about MLTCP plan administrative overhead and care-management consistency.

The Effective Date and the Misreporting

Operative effective date: April 1, 2028, OR earlier upon a Commissioner of Health certificate of readiness. NOT April 1, 2026 as widely cited in older trade press. The April 1, 2026 figure is wrong.

What It Would and Would Not Affect

• MAP and PACE are NOT in scope. The bills target MLTCP only.
• Status as of May 2026: Pending, not enacted. The bills have moved through committee in prior sessions and remain active.

Treat the Home Care Savings & Reinvestment Act as pending legislation worth flagging, not as a likely 2026 reality.

Free Help: Where to Turn When Something Goes Wrong

• ICAN (Independent Consumer Advocacy Network), 1-844-614-8800. Operated by Community Service Society of NY. The right first call for MLTC denials, NYIAP appeals, plan-switch disputes, MAP appeals navigation.
• NY Legal Assistance Group (NYLAG), 1-212-613-5000. Free legal help for low-income New Yorkers on MLTC and CDPAP issues. Lead counsel in Engesser v. McDonald.
• Empire Justice Center. Statewide policy and direct legal representation; co-publishes NY Health Access.
• Medicare Rights Center, 1-888-466-9050. Particularly valuable for MAP appeals during the 1/1/2026 bifurcation.
• HIICAP / NY Medicare Help, 1-800-701-0501. State-funded SHIP program; free Medicare and MAP plan counseling.
• NYSOFA Area Agencies on Aging, 1-800-342-9871. Local senior services, benefits counseling, ombudsman referrals.
• NY State OTDA Office of Administrative Hearings, 1-800-342-3334. To file a State Fair Hearing.
• NY State Long Term Care Ombudsman Program. Operated by NYSOFA under 42 USC § 3058g for nursing-home and assisted-living residents.

A Medicaid-planning attorney is appropriate for asset protection, pooled-income trust setup, spousal-refusal strategy, or LTC-eligibility crisis. The NYSBA Elder Law Section directory and the NAELA New York chapter directory are good starting points.

Common Misconceptions About New York MLTC

1. "The 30-month community lookback is in effect." It is NOT as of May 2026. Enacted in 2020, postponed every year since. Only the federal 60-month institutional lookback applies.
2. "MLTC Policy 21.02 governs lock-in." The operative policy is 21.04.
3. "S2332-A repeals MLTCP April 1, 2026." The actual effective date is April 1, 2028, OR earlier upon a Commissioner of Health certificate of readiness.
4. "The 2026 FAI MMP nationwide termination affects NY MAP members." It does not. NY exited FAI in 2019.
5. "Maximus is independent." Maximus operates BOTH NY Medicaid Choice AND NYIAP. ICAN exists as the independent ombudsman.
6. "There is a 60-hour weekly CDPAP cap." No such cap exists in any NYSDOH directive, statute, or regulation. The IRP review trigger at 12+ hours/day is medical-necessity review, not a cap.
7. "MLTCP covers full long-stay nursing-home placement." It does not. PHL § 4403-f(7-a) caps MLTCP coverage at the first 3 months. MAP and PACE do not have this cap.
8. "You can enroll in MAP without first being on an MLTCP plan." You cannot. EAE under 42 CFR 422.514(h) requires MLTCP-then-MAP sequencing.
9. "PACE has a lock-in." PACE has no lock-in. Disenroll any time.
10. "PACE applicants must clear the September 1, 2025 ADL floor." PACE is exempt; the NF-LOC test is the only functional eligibility threshold.
11. "NY is a 209(b) state." NY is a 1634 state per SSA POMS SI 01715.020 and CMS State Medicaid Manual Chapter 3. The 209(b) states are CT, HI, IL, MN, MO, NH, ND, VA only.
12. "HARP and MAP can be combined." They cannot. A member must choose one.
13. "FIDA-IDD ended when FIDA ended." FIDA closed 12/31/2019; FIDA-IDD remains active.
14. "NHTD and TBI waivers were carved into MLTC in the FY 2026 budget." They were not. The administrative carve-in target is January 1, 2027.
15. "Aid Continuing requires you to wait for plan internal-appeal exhaustion." It does not. Aid Continuing under 18 NYCRR § 358-3.6 requires the appeal request before the effective date of the action OR within 10 days of notice. Many members miss the window because they wait for exhaustion (which is not required under FY 2017 budget reform).

Frequently Asked Questions

Where to Go Next

• New York Medicaid Programs for Seniors, the hub article tying every NY Medicaid pathway together.
• How to Apply for Medicaid in New York, step-by-step on the four application channels.
• CDPAP in New York, the consumer-directed personal-assistance program now run through PPL.
• Pooled Income Trusts in New York, for income above the Community Medicaid limit.
• Long-Term Care Medicaid in New York, institutional Medicaid, NAMI, and the 60-month lookback.
• MAP and FIDE-SNP plans in New York, fully integrated dual-eligible plans deep dive.
• New York HCBS Waivers, NHTD, TBI, OPWDD, Children's.

If you are not sure where to start, chat with Polaris at brevy.com/chat or call 1-855-555-7733 and a Brevy care navigator will help you map your options.