How to switch MLTC plans in New York: the 90-day window, lock-in, and good cause

A new 90-day grace period starts each time you join a new MLTC plan. The lock-in does not stop you from leaving an MLTC plan for a Medicaid Advantage Plus plan, PACE, a mainstream Medicaid plan, a HARP, an HIV-SNP, a waiver program, or fee-for-service Medicaid, if you are eligible.

The lock-in does not apply to people aged 18 to 20, to people without Medicare, or to people in the exempt or voluntary MLTC groups.

• The plan failed to provide the care, services, or supplies in your plan of care.
• You moved out of the plan's service area (your address on file must be updated first).
• You were enrolled without your consent.
• Your current home care provider does not have a contract with the plan.
• You and the plan agree a transfer is in your best interest.
• The state finds the plan failed its contract in a way that affected members.

1. Find your plan start date on your enrollment letter. Count 90 days to see if you are in the grace period.
2. Pick the new plan first. Call it and ask if your aide or agency works with it, and whether it serves your area.
3. Call New York Medicaid Choice at 1-888-401-6582 (TTY 1-888-329-1541). Say you want to transfer MLTC plans. In the grace period, ask them to note your request.
4. If you are in lock-in, ask for a Good Cause review. For some reasons, NYMC does a three-way call with your current plan. Otherwise, NYMC mails a Good Cause packet within 3 to 5 business days.
5. Return the packet with proof, such as a letter from your agency saying it does not work with your plan.
6. Watch for the decision. The state's FAQ says NYMC decides within 3 business days of getting the completed request, and mails the decision within 3 to 5 business days after that.
7. Confirm the start date with the new plan, and make sure your aide schedule carries over.

• Your Medicaid ID (CIN) and current plan name.
• Your enrollment letter with the start date.
• The name of the new plan.
• For good cause: letters, notes of missed visits, or proof of your move.

• Calling the new plan only. The transfer must go through New York Medicaid Choice.
• Missing the 90-day window because you were waiting to see how things go.
• Moving without updating your address with HRA or your county first. NYMC can't approve a move-based transfer until the address is updated.
• Assuming a plan switch changes your hours automatically. The new plan does its own assessment and plan of care. If hours are cut, see our MLTC enrollment steps and the appeal rights in your notice.