MLTC plan says you no longer meet Minimum Needs? What the disenrollment letter means in New York

• Members of partial-capitation MLTC and Medicaid Advantage Plus (MAP) plans without Plan Legacy. In general, that means people who joined MLTC on or after September 1, 2025, when the Minimum Needs Requirement started.
• Not members with Plan Legacy. People enrolled in MLTC before September 1, 2025, with no break in enrollment, are reassessed under the older criteria. Policy 26.01 does not list the Minimum Needs reason for them.
• Not PACE. MLTC Policy 25.04 says the Minimum Needs criteria do not apply to PACE enrollment.

The test itself: needing at least limited assistance with physical maneuvering with more than two everyday activities (ADLs), or, with an Alzheimer's or dementia diagnosis, at least supervision with more than one. The full explanation is on the Minimum Needs page.

1. The reassessment. A reassessment (the Community Health Assessment, usually done once a year) finds that the member no longer meets the Minimum Needs Requirement.
2. The plan must act fast. Policy 26.01 says the plan must start the involuntary disenrollment process within five business days of that assessment.
3. The Intent to Disenroll letter. The plan sends it to the member and any authorized representative before sending the request to New York Medicaid Choice.
4. The request goes to New York Medicaid Choice. It includes the assessment date and, for a member with Alzheimer's or dementia, form DOH-5821.
5. A monthly schedule. The disenrollment date depends on when New York Medicaid Choice receives and accepts the request.
6. The confirmation notice. New York Medicaid Choice mails an Involuntary Disenrollment Confirmation Notice. The policy says fair hearing rights, including aid to continue, apply to it.
7. The result. The member is moved to regular fee-for-service Medicaid. Before the effective date, the plan must make referrals to the local social services office, other community resources, and providers to help with the transition.

• Medicaid continues. This is a plan disenrollment, not a Medicaid closing. The policy treats Medicaid closings by HRA or the county as a separate process.
• Plan home care ends on the disenrollment date, unless a fair hearing with aid to continue keeps it in place while the case is decided.
• Regular Medicaid uses the same test for new home care requests. Personal care and consumer directed services outside a plan apply the Minimum Needs Requirement to people first assessed on or after September 1, 2025. Do not assume the same hours will simply move over.
• MAP members: a MAP plan combines Medicare and Medicaid. Ask the plan and HIICAP (1-800-701-0501, free Medicare counseling) what happens to the Medicare side.
• Non-Medicaid help exists. People 60 and older can ask their local Office for the Aging about EISEP in-home help. NY Connects explains other long-term care options.

1. Write down three dates: the date on the Intent to Disenroll letter, the assessment date, and any disenrollment date. Keep every envelope.
2. Ask the plan for the assessment results and ask, in writing, whether the member has Plan Legacy.
3. If there is an Alzheimer's or dementia diagnosis, get form DOH-5821 done. A doctor, nurse practitioner, or physician assistant completes it. Without it, the lower dementia test cannot be used.
4. When the New York Medicaid Choice notice comes, decide right away about a fair hearing. Call 1-800-342-3334 or use the hearing request form sent with the notice. Asking before the disenrollment date is what keeps services in place.
5. Get free advocacy. ICAN, New York State's ombudsprogram for people with Medicaid who need long term care, is at (844) 614-8800 (TTY 711).
6. Ask the plan what referrals it made for care after the disenrollment date, as the policy requires.

• Signing a voluntary disenrollment to make the problem go away. It ends the plan just the same, and a member with Plan Legacy who leaves MLTC loses that status.
• Waiting for the second letter. The plan letter is the warning. Use that time to gather the assessment, the DOH-5821, and help.
• Thinking Medicaid has ended. It has not, unless HRA or the county sent its own notice.
• Missing the hearing date. Aid to continue depends on asking in time. Read the deadline on the notice the day it arrives.

Does disenrollment from MLTC mean I lose Medicaid?

No, not by itself. Policy 26.01 says members disenrolled for not meeting the Minimum Needs Requirement go to regular fee-for-service Medicaid. Ending Medicaid is a separate decision made by HRA or the county, with its own notice.

Can I keep my home care while I appeal?

Policy 26.01 says fair hearing rights, including aid to continue, apply to the disenrollment notice from New York Medicaid Choice. Ask for the hearing as soon as that notice arrives and before the disenrollment date it shows. The notice lists the exact deadlines.

I joined my plan before September 2025. Can this happen to me?

Members with Plan Legacy are reassessed under the older criteria, and Policy 26.01 lists the Minimum Needs reason only for members without Plan Legacy. If you get this kind of letter and think you have Plan Legacy, ask the plan to confirm your status in writing.

My parent has dementia. Does that change anything?

It can. The test is lower for people with an Alzheimer's or dementia diagnosis: needing at least supervision with more than one everyday activity. The diagnosis has to be on form DOH-5821, completed by a doctor, nurse practitioner, or physician assistant.

Can the plan ask me to just sign a voluntary disenrollment?

A member can ask to leave a plan at any time, but Policy 26.01 says a plan may never pressure or coerce a member into agreeing to a disenrollment. Do not sign anything you do not understand. Call ICAN first.