Managed Long Term Care

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    Jul 05, 2013
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Managed Long Term Care (MLTC) is a capitated payment program that provides long term care in both community and residential settings. Capitated means that health care professionals, such as physicians and nurses, are paid a set amount for the health care of a person that is assigned to them, within a given timeframe. The word capitated may be more fully understood by referring to the phrase "per capita” which means "per head” or, for each individual.

Integrated care delivery and care management are included in Managed Long Term Care plans, that are plans which are alternatives to Medicaid fee-for-service plans.

In New York State, MLTC is made possible through the Medicaid NY program.

What is the Background of MLTC?

Article 44 of the New York Public Health Law was amended by the Long-Term Care Integration and Financing Act of 1997. The amendment was made as a demonstration project for the integration of alternative financing and long-term care service delivery through Managed Long Term Care plans.

MLTC aims to:

1.    prevent or delay the onset of chronic medical conditions
2.    reduce utilization of the health care system, and,
3.    decrease fragmentation of care for the consumer, while simultaneously avoiding the high cost of care in an institutional setting.

Can Anyone Avail of Managed Long Term Care Plans?

Membership or enrollment in a Managed Long Term Care plan is not mandatory, but voluntary.

What Medicaid does is something known as "spreading the risk.” That is to say, Medicaid pay a fixed monthly amount per member, aware of the fact that there are members who require a lot of medical services, while some members need only a few or minimal medical services.

Are Health Care Providers Adequately Compensated Under MLTC?

Under the MLTC, it is immaterial whether health care is actually availed of or not by the person assigned to health care providers or medical professionals contracted to MLTC.

Providers may be fully capitated, which means all payments they receive are capitated. They may also be partly capitated, which means providers only bill some services as fee for service.

There have been concerns about MLTC as a health care delivery system that affects the bottomline of health care providers. This is because some see capitated payments as conflicting with the need to provide adequate and needed quality health care, with the need of of health care providers to make a profit in order to stay in business.

Therefore, there is an underlying concern that persons with clearly bigger medical needs will not be allowed to enroll in an MLTC plan, an action which is known as "cherry picking.”

However, under Federal Law, it is expressly required that Medicaid managed care plans should be made available in the same degree that  Medicaid fee-for-service is available. "Cherry picking” is also forbidden under Federal regulations.

With such kind of federal law protection, a Managed Long Term Care plan in New York state is clearly beneficial for both enrolled individuals and contracted medical professional or health care providers.

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