MRT Update: Nursing Homes Benefit Change

Date Issued: 1/16/2015

Benefit Change: Permanent Nursing Home Stays

Phase I: New York City Residents
Effective February 1, 2015, the Medicaid Managed Care (MMC) nursing home benefit will be expanded to include coverage of permanent stays in residential health care facilities for Medicaid recipients aged 21 and over who reside in the five boroughs of New York City.

Medicaid recipients in permanent nursing home status prior to February 1, 2015 will continue to be covered by Fee for Service Medicaid.

MMC plans will be responsible for members who enter permanent resident status on and after February 1, 2015, and these members will no longer be disenrolled from their managed care plan.

Phase II: Nassau, Suffolk and Westchester County Residents
Effective April 1, 2015, the MMC nursing home benefit will be expanded to include Medicaid recipients aged 21 and over who reside in Nassau, Suffolk and Westchester counties.

Voluntary Enrollment

Effective October 1, 2015, eligible New York City, Westchester, Nassau and Suffolk county Medicaid recipients who were in permanent residence in a nursing home will be able to enroll in managed care on a voluntary basis.