New York’s Managed Long Term Care (MLTC) program provides or arranges for and coordinates both the health care and long term care needs of hundreds of thousands of vulnerable patients with complex health conditions. The following member* stories offer real examples about how MLTC plans support the health care needs of New York’s most vulnerable residents.
* Some names have been changed to protect member privacy
Many people think Managed Long-Term Care Plans (MLTCPs) only care for members who are 65 and over, but Jonathan – who at the age of 29 was a victim of a drive by shooting – tells a different story.
Lauren, 67, has some physical health issues, but her real challenges are related to mental health — specifically, she suffers from schizophrenia as well as substance abuse which has led to Methadone dependence.
Harun was born in Egypt and emigrated to Brooklyn in the 1970s. Always a hard worker, suddenly about twelve years ago, a spinal cord injury – as the result of a tragic accident – left him as a quadriplegic who is totally dependent on others. Through his MLTC plan, Harun receives two 12-hour shifts of care, seven days a week.
With more than 30 years of experience, Margie, a nurse with Nascentia Health, a managed long term care plan in Central New York, understands that calls about a patient needing immediate attention are not unusual. Then came the early morning call telling her that her mother had fallen and Margie’s role changed from nurse to daughter of a patient.
At 102, Nicola has been a member of her Medicaid plan since 2007 when it was the Lombardi program – a predecessor of New York’s MLTC program. When Lombardi was being phased out in 2013, she made the decision to transition into her plan’s MLTC program because she loved her care management team and the services that were provided. She did not want to experience any changes or disruption then, and nearly 10 years later, she feels even more strongly about staying with the plan and the team she trusts.
Many believe MLTC plans are just for seniors, but they also care for members like Howard who joined his plan nearly 10 years ago at age 59. He suffers from numerous chronic disorders including diabetes, coronary artery disease, heart failure, and high blood pressure.
A critical component of Medicaid plans is the relationship between care manager and member. When the member only speaks a foreign language, in this case Cantonese, and their care manager can speak with them directly – without a translator – it often takes that bond to a very special level. That is certainly the case for Mae. She became a member of the Lombardi Program – a predecessor of New York’s MLTC program – in 2009 and, when the program ended in 2013, made the decision to transition to her plan’s managed long-term care program so that she could keep her personal care worker and care manager. That commitment has not changed.
Alex is 75 years old, lives in the Murray Hill section of NYC, is immunocompromised and suffers from a severe cardiac condition. He has been a member of his MLTC plan since 2016 and values the important role his care manager plays in his safety and wellbeing. As part of his care plan, Alex receives much needed assistance with activities of daily living from a personal care worker.
Galy, who is 72 and lives in Valley Stream, has a number of serious chronic conditions — high blood pressure, heart disease, a history of mini-strokes, and arthritis — that require her to have a personal care worker provide assistance with bathing, dressing and meals in order to remain safely in her home. Galy has been a member of her MLTC plan since 2018 and values the important role her care manager plays in her safety and wellbeing.
Mary, an 82-year-old who has multiple sclerosis, osteoporosis and asthma, requires assistance with toileting, taking medications, preparing meals and transportation to her medical appointments.
Since enrolling in his MLTC plan in 2019, Chet, who is 59 years old and has multiple serious health conditions, says his health has been stable and his quality of life is improved. Dealing with bipolar disorder, hypertension, Type 2 diabetes, systemic Lupus and more, keeping everything in check is a group effort.
Darnell is 52 years old, lives in Manhattan and has been enrolled in his MLTC plan for five years. He suffers from Multiple Sclerosis and hypertension. During a regular monthly check in, his case manager asked how he was doing managing his blood pressure and Darnell reported he didn’t “have a machine.”
At the age of 94, bed bound and with dementia and stage 4 chronic kidney disease, Mitch still lives in his home in the Bronx. This remains possible thanks to his MLTC plan where he’s been enrolled for four years.
A member of his MLTC plan for six years, Stan, who is 65 and lives in the Bronx, has multiple health conditions include anxiety, atherosclerotic heart disease, paranoid schizophrenia, neuromuscular dysfunction of his bladder, and vitamin deficiencies, among other things.
Concerned about his declining health and increased care needs, Ralph enrolled in an MLTC plan in May 2021. At 88 years old, Ralph and his wife live in East Setauket with very limited support at home and in the community.
Pamela was heathy and independent until contracting viral encephalitis a year ago, which left her with weakness, short term memory loss, and the inability to take care of herself and do basic tasks such as shopping, cooking and meal preparation, bathing and dressing.
Eddie has been enrolled in his MLTC plan for two years. He is 51 years old, lives in the Bronx and has been diagnosed as bipolar and has asthma.
Though her name is Gladys, everyone calls her “Sunshine” because she keeps a positive attitude and makes people smile even during dark times like the coronavirus pandemic. At 79, Gladys lives in Brooklyn by herself and has been enrolled in her MLTC plan for almost three years.