If you or your loved one has a long-lasting medical condition or disability — you may be considering enrolling onto a Medicaid Managed Care Plan.
But which one? Not all Medicaid plans cover long term in-home care, as such it is important to know which ones do cover the benefit to avoid plan-selection remorse.
First we will cover the plan-type that provides it’s enrollees the most flexibility, the Managed Long Term Care Plan or “MLTC” for short. If Medicaid were a pizza pie, the MLTC would manage just a slice of that pie. For benefits that are not listed, enrollees may still utilize their straight Medicaid or Medicare, which is why this is considered the most flexible plan-type out of the 4 we will be reviewing.
MLTC plans are intended for those that need long term care for more than 120 days. Take note that you have to be 21 years or above to enroll on one of these plans.
The MLTC plans primary focus is on home care and long term care services. Home health aides, physical therapists, and nurses may be dispatched to help with provide services, as long as they are deemed medically necessary by the plan. Some specialty health services are also covered benefits in these plans…most notably audiology, dental, optometry, and podiatry.
Aside from that, they also provide social day care, personal emergency response, home modifications and non-emergency transportation to medical appointments. As we stated before, you have the most freedom with MLTC’s.
The next Managed Medicaid Care plan-type that we will be covering are Medicaid Advantage Plus Plans or “MAP” for short.
Medicaid Advantage Plus Plans are for people who want all their Medicaid/Medicare medical needs covered/managed within one plan — doctors, hospital, and home care. MAP plans covers both Home Health Aide services and also the CDPAP benefit. The long term care services offered are the same as MLTC but there are several Medicare services covered as well.
Here’s just a few:
• Doctor office visits
• Specialty care
• Clinic visits and hospital stays
• Mental health services
• X-ray and other Radiology services
• Chiropractic care
• Medicare part D drug benefits
• Ambulance services
The next Medicaid Managed Care plan-type we will be covering is the Program for All-Inclusive Care for the Elderly or “PACE” for short.
Many individuals whom select this plan-type are interested in receiving community based services, and are also seeking a centralized dedicated care team under one single roof. To enroll, you need to be at least 55 years old. PACE primarily revolves around the enrollee’s adult day health center that not only promotes care but also socialization among plan members.
Compared to the other plans, PACE services are handled by an interdisciplinary provider team. This team is comprised of professional and paraprofessional staff. They assess the member’s needs, develop care plans, deliver services, and ensure that all needs of the member — social and medical will be addressed.
Some of the Medicaid and Medicare services covered under this program are:
• Emergency services
• Hospital care
• Home Health Aide service and CDPAP
• Laboratory/x-ray services
• Medical specialty services
• Nursing home care
• Nutritional counseling
• Occupational therapy
• Physical therapy
• Prescription drugs
• Primary care (including doctor & nursing services)
• Recreational therapy
• Social services
• Social work counseling
The final Medicaid Managed Care plan-type we will be covering are Fully Integrated Dual Advantage Plans or “FIDA” plans for short.
This is a very complete care package. Providing all the care an enrollee may need, managed by their FIDA plan-operator or insurer. The goal for FIDA plans are to provide more coordinated care for individuals that are enrolled in Medicare and Medicaid while reducing expenditures.
An individual eligible for a FIDA plan, would be assigned a care manager that helps them identify what care and help they’re seeking. Depending on the insurer operating the FIDA plan, the care manager may be a nurse, doctor, or a specially trained educator who would also be able to give advice on how the enrollees health should be managed. In a FIDA plan, members also have the option to provide feedback in putting together their care team of doctors and specialists to devise a plan that will be more tailored to that individuals specific needs.
The coverage within the plan include many of the benefits you will get from the MLTC Medicaid plan, as well as Part D drug benefits, mental health care, and transportation.
You are free to choose which plan works for you. It is advised that before making a final decision, you discuss your options with the people who help you make medical decisions like immediate family members and physicians.
If you need help in finding the right plan for you, shoot us a message below, we’re eager to help!
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