Managed Long Term Services & Supports (MLTSS)

Click below to download the MLTSS Brochure

What is MLTSS?

Medicaid Managed Long-Term Services and Supports (MLTSS) allows Members to access their traditional Medicare (medical) benefits while receiving their Medicaid covered benefits through NextLevel Health.

Members who are enrolled in both Medicare and Medicaid are known as “dual eligible.” If you receive Home and Community Based Waiver services or reside in a nursing home, you may choose to receive care for covered services through the Medicare and Medicaid Alignment Initiative (MMAI) or MLTSS program.

Medicare Benefits & Options

Medical benefits are provided by Medicare as the primary payer. Participants must be enrolled in a Medicare A, B and/or D plan. Depending on the Medicare covered benefits, premiums and deductibles are covered by Medicaid and/or by one’s enrollment in a Medicare Advantage Plan – Part C.

Who Qualifies for MLTSS

Have you been approved for both Medicare and Medicaid? Do you
currently live in a nursing home or long-term care facility? Or are you receiving Home and Community Based Services through one of the State’s Waiver programs? You may qualify for NextLevel Health’s MLTSS program.

Illinois Waiver Programs provide assistance and services to allow you to remain in the community:

1. Persons on the Elderly Waiver
2. Persons with Disabilities Waiver
3. Persons with HIV/AIDS Waiver
4. Persons with Brain Injury Waiver
5. Persons living in a Supportive
6. Living Facility

For more information or to apply for waiver services contact:

Age 19-59:
Contact Illinois Department of Human Services-Division of Rehabilitation Services: 1-800-843-6154

Age 60 and over:
Contact Illinois Department on Aging: 1-800-252-8966

MLTSS Enrollment

When a beneficiary is eligible for automatic enrollment in both MMAI and MLTSS, Illinois Client Enrollment Services will mail him or her an MMAI automatic enrollment notice. Beneficiaries who opt-out of MMAI will be required to enroll in MLTSS if they live in a nursing facility or receive waiver services.

Dual eligible (Medicare and Medicaid) individuals who reside in a nursing facility or receive waiver services, must enroll in either an MMAI program or the MLTSS program.

During the enrollment period, members may call the Illinois Client Enrollment Broker at 1-877-912-8880 to change their plan.

After enrollment, MLTSS enrollees have a 90-day switch period and then are “locked in” for one year.

MLTSS Covered Services

Managed Long Term Services & Supports (MLTSS)

NextLevel Health MLTSS Members receive Medicaid benefits in addition to their Medicare-covered benefits. Below is a list of the benefits you may be eligible to receive when you qualify for the service as a NextLevel Health Member in the MLTSS program. There may be benefit limitations or some services may require a prior authorization.

Home and Community-Based Services

If you are approved by the State of Illinois for one of the waiver service programs, you may be qualified to receive the following services, as part of your Individual Plan of Care. For more information about Home and Community Based Services and Waiver programs, please reach out to your NextLevel Health Care Coordinator.

Managed Long Term Care Program