Resumption of Certain MLTC Involuntary Disenrollments

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TO: All Medicaid Managed Care (MMC) Plans, including Mainstream MMC, Medicaid Advantage, HIV Special Needs Plans (HIV SNP), Health and Recovery Plans (HARP), Managed Long Term Care Plans (MLTC), including Partial, Medicaid Advantage Plus and Program of All Inclusive Care for the Elderly (PACE):

SUBJECT: COVID-19 Extension of Medicaid Coverage

The Families First Coronavirus Response Act (Act) and existing federal regulations provide that individuals covered by Medicaid as of March 18, 2020 will not lose Medicaid coverage. As a result, DOH will be extending all Medicaid active cases and MMC plan enrollment for members with coverage end dates in March, April, May or June, except for case closings due to client request, moving out of state, or death. For further background on the Act, please see the CMS FAQ.

MMC plans should expect an increased number of enrollment reinstatement transactions for April:

  1. ALL MMC PLANS: For cases at local districts cases (WMS), the April 6th managed care secondary roster will include MMC plan members who were scheduled for disenrollment but whose coverage and enrollment have been extended under the Act.
    • MMC plans should expect an increased number of members on the secondary roster who would not have appeared on the primary roster or on the disenrollment report.
    • There will also be an increase in necessary reinstatements for additional plan members whose coverage was not extended by the secondary roster.
    • Following the April 6th secondary roster, DOH will provide MMC plans with a final list of plan members with extended coverage and enrollment.
    • MMC plans should take no action to end coverage prior to receipt and processing of the final list of April enrollments from DOH.
  2. MAINSTREAM, HARP and HIV SNP: NY State of Health (NYSoH) will be extending cases. MMC plans should expect an increased volume of 834 enrollment transactions. More information will be provided to MMC plans from NYSoH.

Thank you for your attention and cooperation in supporting your members. If you have any questions, please contact:

Mainstream, HARP and HIV SNP: mcsys@health.ny.gov
MLTC Plans: mltcinfo@health.ny.gov