Medicaid Advantage Plus (MAP)

Eligibility for Enrollment into a Medicaid Advantage Plus plan

The eligibility criteria for Medicaid Advantage Plus (MAP) plans, in accordance with Public Health Law § 4403-f, requires individuals to be assessed as needing community based long term services and supports (CBLTSS) for more than 120 days and the following:

• at least limited assistance with physical maneuvering with more than two activities of daily living (ADLs); or
• individuals with a Dementia or Alzheimer's diagnosis, assessed as needing at least supervision with more than one ADL.

The MAP program is a type of plan for people 18 years of age or older who have both Medicare and Medicaid. The MAP plan works together with a Medicare plan to administer all of your Medicare, Medicaid, long term care, and drug benefits under one health care organization.

You are eligible to join the MAP Program, if you meet all of the following requirements:

1. Are age 18 or older,
2. Reside in the Plan's service area,
3. Have Medicaid,
4. Have evidence of Medicare Part A & B coverage,
5. Enroll in the MAP plan’s aligned Medicare Advantage Dual Special Needs Plan
6. Are capable at the time of enrollment of returning to or remaining in your home and community without jeopardy to your health and safety or you are permanently placed in a nursing home, and
7. Must be assessed as needing at least one CBLTSS for more than 120 days and the following:
• are assessed as needing at least limited assistance with physical maneuvering with more than two activities of daily living (ADLs); or
• individuals with a Dementia or Alzheimer's diagnosis, assessed as needing at least supervision with more than one ADL.

CBLTSS includes services provided in the home or community setting (any place of residence, either permanent or temporary, other than a hospital, skilled nursing home, or health related facility) as included in the MAP plan benefit package and provided by the MAP plan when medically necessary. CBLTSS services includes Private Duty Nursing, Skilled Nursing, Home Health Services, Personal Care Services*, Consumer Directed Personal Assistance Services, and Adult Day Health Care.

Note: Level 2 requires physical assistance with activities of daily living. Services such as housekeeping and shopping do not meet the need for level 2 services. More information is available in Title 18 - 505.14.

Service Authorization, Appeals, and Notices

• Partial, MAP, and PACE

MAP Model Contract

• Medicaid Advantage Plus (MAP) (PDF)

NYS Model Member Handbooks

• Medicaid Advantage Plus - (Web) - (PDF)

NYS Contracted Health Plan Provider Directories

• Partial and MAP

NYS Contracted Health Plan Ownership and Control Interest Information

• Partial, MAP, and PACE (XLSX)

NYS Contracted Health Plan Network Adequacy Standards

• Network Adequacy Standards
• To see if a specific provider participates with a specific managed care organization, please visit here.