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MLTC Enrollment in New York: What the 2025-2026 Changes Mean for Your Family
MLTC Enrollment in New York: What the 2025–2026 Changes Mean for Your Family
If your family has been navigating Medicaid home care in New York, 2025 and 2026 brought two important developments that are worth understanding before you begin — or restart — the enrollment process.
What Is MLTC?
Managed Long-Term Care (MLTC) is New York State’s Medicaid program that covers in-home care services for people who need long-term assistance with daily living. It pays for home health aides (HHAs), personal care aides (PCAs), nursing visits, and therapy services — delivered at home rather than in a facility.
MLTC is the most widely used pathway to Medicaid home care for elderly and disabled adults in New York City. Enrollment is managed through MLTC plans (such as VNS, ArchCare, or Centers Plan), which coordinate your care and authorize the hours your loved one receives.
What Changed in 2025–2026
1. Dementia is now a qualifying condition (September 2025)
Before September 2025, a diagnosis of dementia alone was not sufficient to qualify for MLTC. The individual had to meet nursing-home level of care criteria, which often required significant physical disability in addition to cognitive decline.
New York State updated its eligibility rules in September 2025 to explicitly include dementia — including Alzheimer’s disease — as a qualifying condition for MLTC enrollment. This means families caring for a loved one with dementia who had been told they didn’t qualify may now be eligible.
If you were previously denied, reapply.
2. The waitlist grew 76% since December 2024
Total MLTC enrollment in New York State reached approximately 364,784 people as of October 2024, and the system is under significant strain. Processing times for new applications have extended considerably in some boroughs. Families who delay applying — especially those who have recently become eligible under the dementia rule change — are finding the wait substantially longer than it was a year ago.
The practical implication: apply as early as possible, even if services aren’t needed immediately.
How MLTC Enrollment Works
1. Medicaid eligibility first — the individual must be enrolled in Medicaid before MLTC enrollment can proceed. Income limits apply; an elder law attorney or enrollment specialist can help with asset protection if needed.
2. UAS-NY assessment — the Uniform Assessment System (UAS-NY) is a clinical assessment of the person’s functional needs. It determines how many authorized care hours they receive. The assessment is conducted by a nurse and takes about an hour in the home.
3. MLTC plan selection — you select a managed care plan. Different plans have different provider networks, so if you have a preferred agency or caregiver, confirm they’re in-network before enrolling.
4. Authorization and placement — the plan authorizes the care hours and works with a home care agency to schedule an aide.
Priority Groups assists families with free MLTC enrollment support — including Medicaid application coordination, UAS-NY scheduling, and plan navigation. We serve families in Brooklyn, the Bronx, Queens, and Manhattan.