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:
- Persons on the Elderly Waiver
- Persons with Disabilities Waiver
- Persons with HIV/AIDS Waiver
- Persons with Brain Injury Waiver
- Persons living in a Supportive
- 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
| Type of Care | Description | Benefit Limit |
|---|---|---|
| Adult Day Service (also called Adult Day Health) | A program that provides medical and rehabilitative services to adults in a group setting during the day |
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| Adult Day Service Transportation | Transportation service to and from the Member’s home to access Adult Day Services |
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| Environmental Modifications of the Home | Physical adaptations to the Member’s residence necessary to ensure the health, welfare, and safety of the Member, or to enable independent living |
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| Vehicle Modifications | Physical adaptations to the member’s vehicle to enable independent living |
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| Home Health Aide | Certified Nursing Assistant hired who is supervised by a medical professional to assist with basic health services, such as therapies, nursing care, and medication assistance |
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| Nursing, Intermittent | Registered professional nurse or licensed practical nurse services for long-term needs |
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| Nursing, Skilled (Home Health) | Shift nursing services by a licensed registered nurse or licensed practical nurse for short-term acute healing needs to restore and maintain your health and function. |
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| Occupational Therapy | Licensed occupational therapist services focused on long-term needs to help you perform daily activities and prevent loss of function |
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| Physical Therapy | Physical therapy services focused on long-term needs to help you with movement and prevent loss of function |
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| Speech Therapy | Speech therapist services focused on long-term needs to help you with speaking and language skills |
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| Prevocational Services | Services to prepare for employment that is not job-task related if it is expected that you will get a job or join a transitional sheltered workshop within one (1) year |
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| Habilitation Day Services | Services for Members with brain injury to acquire, retain, or improve your self-help, socialization, and adaptive skills; this service is provided outside of the home |
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| Homemaker Services | General and nonmedical support by trained homemakers to assist members with activities of daily living such as laundry, shopping and cleaning |
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| Home Delivered Meals | Prepared food brought to a Member’s home for a Member who cannot prepare his/her own meals but is able to feed him/herself |
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| Individual Provider | Assistance with eating, bathing, personal hygiene, and other activities of daily living, as well as housekeeping chores in the home and at work (if applicable) by an individual who meets State standards and is employed by the Member to provide these services |
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| Personal Emergency Response System (PERS) | An electronic system and device to call for help in an emergency |
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| Respite | Services that provide relief for unpaid family or other primary caregivers who meet all the Member’s support with activities of daily living, when it is necessary for the caregiver to be absent |
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| Nurse Training | Child focused training for nurses by an approved nursing agency, in the use of new or unique prescribed equipment, or special needs of the child |
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| Family Training | Training for families of Members about treatment regimens and use of equipment; may include CPR training |
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| Specialized Medical Equipment and Supplies | Devices, controls or appliances that enable you to perform activities of daily living, or to manage in your home; includes items needed for life support, ancillary supplies and equipment; durable medical equipment not available through the standard non-waiver Medicaid benefit |
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| Supported Employment | Supports to enable employment such as a vocational assessment, job development, and placement, and work adjustment training |
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| Behavioral Services | Remedial therapy by a masters or Ph.D.-level speech therapist, social worker, psychologist, or counselor to assist Members to manage behavior and cognitive functioning and to enhance ability for independent living Includes Mental Health Rehab Option Services, targeted case management, Licensed Clinical Professional Counselor or other behavioral health services |
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| Alcohol and Substance Abuse Rehabilitation Services | Treatment for a substance problem, such as alcohol abuse or drug abuse. Services include but are not limited to residential treatment, outpatient, inpatient, day treatment, detoxification, and psychiatric evaluation services. |
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| Assisted Living | Supportive Living Facility services in a private apartment setting that meet your daily living needs 24 hours a day. Some examples of services included are nursing services, personal care, medication assistance, laundry, social and recreational programs |
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