By Long Island Senior Advisor Care Team · August 24, 2026
MLTC enrollment has been mandatory in Nassau and Suffolk since the 2013 transition for Medicaid recipients needing more than 120 days of community-based long-term care. Here is what that actually means for a Hempstead family arranging home care.
A Hempstead Scenario That Explains the Whole System
A woman living in the Village of Hempstead is dual-eligible for Medicare and Medicaid. She has been managing with a home health aide a few hours a day since a fall last winter, paid for through her regular Medicaid home care authorization. Her daughter, who lives nearby and drives her to Nassau University Medical Center in East Meadow for appointments, gets a letter saying her mother's care is being transitioned into a Managed Long Term Care plan. Nothing about her mother's condition has changed. The letter alone raises the obvious question: what is MLTC, and why is a new plan suddenly involved in decisions that used to run straight through Medicaid?
The short answer is that once a Medicaid recipient in Nassau or Suffolk needs more than 120 days of community-based long-term care, New York State requires that care to move from a fee-for-service Medicaid arrangement into a managed care plan. That has been the rule in both counties since the transition that began in 2013. It is not optional, it is not a downgrade, and it does not mean her mother did anything wrong. It means she crossed a duration threshold the state uses to decide who manages her long-term-care benefit.
Hempstead is a useful place to walk through this because it has real transit-accessible senior housing stock already built into the village and sits close to a major hospital hub in East Meadow, which means Medicaid long-term care questions come up here constantly, not as an edge case.
What MLTC Actually Is (and Isn't)
Managed Long Term Care is New York's system for delivering Medicaid long-term-care benefits, including home care, nursing home care, adult day care and related services, through a managed care plan rather than through the traditional fee-for-service Medicaid billing that pays providers directly for each visit.
MLTC has two lines of business. The first is Managed Long-Term Care Plans, which includes a variant called Medicaid Advantage Plus that also folds in Medicare benefits. The second is PACE, the Program of All-Inclusive Care for the Elderly, available to members 55 and older and jointly funded by Medicare and Medicaid. Both exist to coordinate a single member's care through one plan instead of a patchwork of separately billed providers.
What MLTC is not: it is not a cut in benefits, and it is not the same thing as regular Medicaid managed care that covers primary care and hospital visits for younger, healthier Medicaid recipients. It is specifically the long-term-care piece, and it only applies once someone crosses into needing sustained, ongoing community-based care.
Why Mandatory Since 2013 Still Confuses Nassau and Suffolk Families
Mandatory MLTC enrollment reached Nassau and Suffolk counties in 2013, replacing the fee-for-service delivery of community-based long-term care for anyone needing more than 120 days of it. The state's stated reasoning was to coordinate care better and control costs by putting one plan in charge of a member's full long-term-care picture instead of leaving it split across separately billed home care agencies, adult day programs and equipment vendors.
The confusion families run into more than a decade later is timing. A parent can be on regular Medicaid home care for months without anyone mentioning MLTC, then get a transition notice the moment an assessor determines the 120-day threshold has been crossed. Because the letter often arrives without much explanation, families assume something has gone wrong with their case. In the ordinary version of this, nothing has: it is simply the point at which state rules require the case to move into managed care.
It is also worth knowing that mandatory MLTC enrollment is no longer unique to the New York City suburbs. It has since expanded to cover all 62 New York counties, but Nassau and Suffolk were among the earlier counties where the mandate took hold, so Long Island families have been living with this system longer than most of the state.
The 120-Day Threshold and the Minimum Needs Requirement
Enrollment in an MLTC plan is mandatory for individuals who are dual-eligible for Medicare and Medicaid, are age 21 or older, are assessed as needing community-based long-term services and supports for more than 120 days, and meet the state's minimum needs requirement.
That minimum needs requirement has changed. As of September 1, 2025, the floor for MLTC Partial Capitation and Medicaid Advantage Plus enrollment was raised to require limited assistance with three or more activities of daily living, or supervisory-level assistance with two or more activities of daily living if there is a documented Alzheimer's or dementia diagnosis on file. Anyone who enrolled before that date keeps what the state calls Legacy Status as long as they stay continuously enrolled, so an existing Hempstead case is not automatically re-tested against the newer, higher bar.
This is a detail worth confirming directly with a caseworker rather than assuming, since a borderline case that would have qualified in 2024 may not clear the current threshold, and the reverse is also possible depending on how the diagnosis is documented.
Choosing a Plan: MLTCP, Medicaid Advantage Plus, and PACE
Once someone is required to enroll, the practical decision is which plan. Nassau and Suffolk both have multiple MLTC plans operating in the county, and plan networks, participating home care agencies, and service areas can change, so the state's own advice is to confirm current options directly with NY Medicaid Choice or NY Connects rather than relying on last year's list.
A Managed Long-Term Care Plan under partial capitation covers long-term-care services only, leaving Medicare to continue covering hospital and doctor visits separately. Medicaid Advantage Plus combines both Medicare and Medicaid benefits under one plan, which some families prefer specifically to reduce the number of separate cards and contacts involved in a parent's care. PACE, for members 55 and older, goes further still, coordinating essentially all medical and long-term care through one program built around adult day health center participation.
There is no single right answer among the three. A Hempstead family should ask each option directly which home care agencies it already works with in the village, since continuity with an aide the parent already trusts is often the deciding factor in practice, ahead of any difference in plan structure on paper.
What MLTC Does and Doesn't Cover in Hempstead
MLTC plans are built to fund services delivered at home or in the community: home care aide hours, nursing, therapy, adult day health care, medical equipment and transportation to covered services, coordinated through a single care manager assigned by the plan. What it is not built to fund is rent, a mortgage payment, or room and board of any kind. If the actual plan is eventually a move into a licensed assisted living community, MLTC by itself does not solve that piece.
That distinction sends some Hempstead families toward New York's Assisted Living Program instead, which is Medicaid-funded but delivered inside a licensed Adult Home or Enriched Housing Program rather than at home. Our guide to New York's Assisted Living Program covers how that Medicaid pathway works and where it overlaps with, and differs from, MLTC.
It also matters to weigh MLTC-funded home care against the alternative of paying privately, since the two are not automatically equivalent in cost terms even for families who could afford either. The 2025 CareScout Cost of Care Survey puts the New York State median for a non-medical caregiver at $6,673 per month at 44 hours a week, against a $7,110 per month state median for a private one-bedroom assisted living unit. Neither figure is Hempstead-specific, since CareScout publishes state medians only, but the comparison shows why MLTC's coverage of home care hours can matter as much financially as it does logistically.
Where NHTD and ALP Fit Instead
MLTC is not the only Medicaid long-term-care pathway in New York, and it helps to know why the others usually are not the first stop for a Hempstead family in this situation. The Nursing Home Transition and Diversion waiver, administered by the state health department through Regional Resource Development Centers, exists to transition someone out of a nursing facility or divert them from one, and it pays for services only, never room and board or rent. In practice, most Nassau and Suffolk seniors needing ongoing community long-term care are directed toward MLTC instead of NHTD, precisely because MLTC enrollment is mandatory in both counties once the 120-day and minimum-needs thresholds are met.
The Assisted Living Program, regulated under 18 NYCRR Part 494, is the other major piece, but it operates inside a licensed facility rather than at home, covering personal care, housekeeping, nursing, therapy and RN case management delivered on-site. A family choosing between staying at home under MLTC and moving into an ALP-funded community is really choosing between two different Medicaid delivery systems built for two different living situations, not comparing better and worse versions of the same benefit.
Our Medicaid waivers and assisted living guide lays out ALP and MLTC side by side in more detail, including what neither one covers.
Getting Started: Who to Call First
The right first call for a Hempstead family is the same one recommended across Nassau generally: the Nassau County Office for the Aging at 516-227-8900, or NY Connects, which screens for MLTC, ALP and the NHTD waiver and routes the application without charge. Nassau was the first county government in the nation to establish a dedicated agency for its 60-plus population, and Office for the Aging staff can explain, case by case, whether a parent is likely to be assessed at or above the 120-day threshold before a transition notice even arrives.
For a Hempstead family specifically, proximity to Nassau University Medical Center in East Meadow means hospital discharge planners there are often the ones who first flag that a patient's home care needs are trending toward the 120-day mark, so it is worth asking a hospital social worker directly whether an MLTC referral is already in motion before assuming the process hasn't started.
Our Nassau County guide covers the rest of the county-level agency structure, including the Long-Term Care Ombudsman and Adult Protective Services contacts that sit alongside the Office for the Aging, and our Hempstead city guide covers the local housing and care market this family would be weighing alongside the MLTC decision itself.
