MLTC Partial Capitation (MLTCP)

Eligibility for Enrollment into a Managed Long Term Care Partial Capitation plan

The eligibility criteria for Managed Long Term Care Partial Capitation (MLTCP), 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.

Enrollment in a MLTCP plan is mandatory for those who:

  • Are dual eligible (Medicaid and Medicare), age 21 and older, receiving CBLTSS for more than 120 days and meets the Minimum Needs Requirements.
  • Reside in the following counties:
    • Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Montgomery, Nassau, New York City (Bronx, Kings, New York, Richmond and Queens), Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Otsego, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, Schoharie, Schuyler, Seneca, St. Lawrence, Steuben, Suffolk, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington, Wayne, Westchester, Wyoming, and Yates.

Enrollment in a MLTCP plan is voluntary for those who are:

  • Dual eligible individuals, aged 18 through 20, who must be assessed as needing CBLTSS for more than 120 days and meet the Minimum Needs Requirements.
  • Non-dual eligible individuals, age 18 and older, who must be assessed as needing CBLTSS for more than 120 days and meet the Minimum Needs Requirements.

For individuals assessed for enrollment into a MLTCP before September 1, 2025, the MLTC Plan Legacy eligibility requirements apply. Prior to September 1, 2025, individuals were required to be assessed as needing CBLTSS for more than 120 days and dual eligible individuals aged 18 to 20 were required to need nursing home level of care. More information is available in MLTC Policy 25.04 - Minimum Needs Requirement Update to the Eligibility Requirements for Managed Long Term Care Enrollment.

Service Authorization, Appeals, and Notices

MLTC Model Contract

  • MLTC Partial Capitation (MLTCP) - (PDF)

NYS Model Member Handbooks

NYS Contracted Health Plan Provider Directories

NYS Contracted Health Plan Ownership and Control Interest Information

NYS Contracted Health Plan Network Adequacy Standards