Repeals managed long term care provisions for Medicaid recipients; establishes provisions for fully integrated plans for long term care including PACE and MAP plans.
This bill would repeal New York’s partially capitated managed long term care (MLTC) framework and replace it with a new long-term care options structure for Medicaid recipients who need long-term care services for more than 120 days. The bill states that, beginning no earlier than April 1, 2028 and subject to federal approvals and state readiness, eligible adults would receive services through either fully integrated plans such as PACE or a new Medicaid Advantage Plus (MAP) plan, or through a fee-for-service model coordinated by newly established care coordination entities. The measure also preserves PACE as an option and requires the Department of Health to develop waiver requests, guidelines, and transition planning before implementation.
The bill makes extensive conforming amendments across the Public Health Law, Social Services Law, Elder Law, and Mental Hygiene Law to replace references to managed long term care plans with references to PACE, MAP, or long term care options. It also creates requirements for care coordination entities, including minimum county-level availability, conflict-free case management protections, individualized care plans, and provider selection standards. In addition, it directs the department to convene stakeholder advisory groups, report biannually on the transition, and evaluate how the new model affects continuity of care, service utilization, quality, and the direct care workforce.
The bill’s impact on state law is broad and structural. It repeals section 4403-f of the Public Health Law and replaces it with a new long-term care options section, while also revising numerous cross-references in Medicaid, transportation, home care reimbursement, developmental disability managed care, and elder law provisions. It would shift the legal basis for long-term care delivery away from MLTC plans and toward fully capitated plans and fee-for-service arrangements with state-defined coordination requirements, while also extending or adjusting related assessment, reimbursement, and oversight rules through 2028.
The general sentiment reflected by the bill text is reform-oriented and critical of the existing MLTC system. The legislative intent section says the original MLTC model did not evolve as intended into fully capitated plans, and the bill seeks to end the partially capitated structure in favor of a different delivery model. Because there are no committee transcripts or recorded votes provided, there is no direct evidence here of support or opposition from legislators or stakeholders beyond the bill’s own stated policy rationale.
The main points of contention implied by the bill are the shift away from managed long term care, the timing and feasibility of the transition, and the role of fee-for-service versus capitated care. The bill anticipates the need for federal waivers, state readiness determinations, and stakeholder input, suggesting that implementation complexity is a major issue. It also tries to address likely concerns from providers and workers by emphasizing continuity of care, workforce disruption, provider labor stability, and minimum choice requirements for enrollees.
The bill would substantially amend New York’s Medicaid long-term care statutes by repealing the existing managed long term care provision and replacing it with a new framework centered on PACE, MAP, and fee-for-service care coordination entities. It would revise numerous related statutes governing Medicaid eligibility, case management, transportation, home care reimbursement, developmental disability services, and elder law definitions so that references to MLTC are replaced with the new long-term care options structure. The Department of Health would be required to seek federal waivers, establish regulations and guidelines, convene advisory groups, and report on the transition, with implementation delayed until at least April 1, 2028 and conditioned on readiness and federal approval.
The bill appears generally supportive of restructuring long-term care delivery and skeptical of the current managed long term care model. Its legislative intent section explicitly says the existing partially capitated MLTC program did not develop as intended and should be replaced. Because no committee transcript or vote record is provided, there is no direct evidence of external debate, amendments in response to opposition, or recorded support/opposition from lawmakers; the available context only shows the bill was introduced and referred/recommitted to the Health Committee.
The likely areas of contention are whether New York should eliminate the existing MLTC system, whether a fee-for-service model can maintain coordination and quality, and whether the state can implement the transition without disrupting enrollees, providers, and the direct care workforce. The bill itself anticipates concerns about continuity of care, provider labor stability, county-level access to care coordination entities, and the need for federal waivers and readiness certification. Stakeholders most likely to have differing views include managed care plans, home care agencies, fiscal intermediaries, Medicaid recipients, direct care workers, and state agencies responsible for implementation and oversight.