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:

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.

Type of Care	Description	Benefit Limit
Managed Long Term Care Program
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	Cannot be duplicated by other MLTSS services You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify Not for members in a Supportive Living Facility
Adult Day Service Transportation	Transportation service to and from the Member’s home to access Adult Day Services	Limited to trips to and from Adult Day Services; cannot exceed 2 trips in a 24-hour period
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	Limited in scope to meet your medical needs Limited to members of the Disabilities, HIV/AIDS, Brain Injury, or Medically Fragile/Technology-Dependent Waiver programs
Vehicle Modifications	Physical adaptations to the member’s vehicle to enable independent living	Limited in scope to meet your medical needs Limited to members of the Disabilities, HIV/AIDS, or Brain Injury Waiver programs
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	You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify Limited to members of the Disabilities, HIV/AIDS or Brain Injury Waiver programs
Nursing, Intermittent	Registered professional nurse or licensed practical nurse services for long-term needs	Requires a prescription from a primary care provider Limited to members of the Disabilities, HIV/AIDS or Brain Injury Waiver programs
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.	Requires a prescription from a primary care provider Cannot be duplicated by other MLTSS services Limited to members of the Disabilities, HIV/AIDS or Brain Injury Waiver programs
Occupational Therapy	Licensed occupational therapist services focused on long-term needs to help you perform daily activities and prevent loss of function	Requires a prior authorization Duration and/or frequency depends on physician authorization Limited to members of the Disabilities, HIV/AIDS or Brain Injury Waiver programs
Physical Therapy	Physical therapy services focused on long-term needs to help you with movement and prevent loss of function	Requires a prior authorization Duration and/or frequency depends on physician authorization Limited to members of the Disabilities, HIV/AIDS or Brain Injury Waiver programs
Speech Therapy	Speech therapist services focused on long-term needs to help you with speaking and language skills	Requires a prior authorization Duration and/or frequency depends on physician authorization Limited to members of the Disabilities, HIV/AIDS or Brain Injury Waiver programs
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	You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify. Limited to members of the Brain Injury Waiver program
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	You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify. Service is furnished four (4) or more hours per day for one (1) or more days per week unless provided with another day activity under your service plan Limited to members of the Brain Injury Waiver program
Homemaker Services	General and nonmedical support by trained homemakers to assist members with activities of daily living such as laundry, shopping and cleaning	You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify. Not for members of a Supportive Living Facility or Medically Fragile/Technology-Dependent Waiver program
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	Cannot be duplicated by any other services You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify. Limited to members of the Disabilities, HIV/AIDS or Brain Injury Waiver programs
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	Cannot be duplicated by any other services You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify. Does not include the cost of meals Limited to members of the Disabilities, HIV/AIDS or Brain Injury Waiver programs
Personal Emergency Response System (PERS)	An electronic system and device to call for help in an emergency	Limited to Members who live alone, or who are alone for many hours of the day, who have no caregiver for extended periods of time, and require supervision Not for Members of a Supportive Living Facility or Medically Fragile/Technology Dependent waiver program
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	Limited to an Individual Provider, homemaker, nurse, adult day care Limited to members of the Disabilities, HIV/AIDS, Brain Injury or Medically Fragile/Technology Dependent Waiver programs
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	Limited to no more than four (4) hours per nurse per waiver program year Limited to members of the Medically Fragile/Technology Dependent Waiver program
Family Training	Training for families of Members about treatment regimens and use of equipment; may include CPR training	Limited to families of Members in the Medically Fragile/ Technology Dependent Waiver program
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	Requires a prescription from a primary care provider Excludes items which are not of direct medical or remedial benefit Limited to members of the Disabilities, HIV/AIDS, Brain Injury or Medically Fragile/Technology Dependent Waiver programs
Supported Employment	Supports to enable employment such as a vocational assessment, job development, and placement, and work adjustment training	You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify Limited to members of the Brain Injury Waiver program
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	Requires a clinical recommendation You need to meet certain qualifications to receive these types of services. Your Care Team will help you apply for these services if you qualify Limited to members of the Brain Injury Waiver program
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.	None
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	Limited to Members aged 65+ and Members with physical disabilities between 22-64 years of age who are covered under the Supportive Living Facility Waiver program

24/7 Help Line

PHONE: 833-ASK-NLHP (833-275-6547)

TTY: Illinois Relay 711

Para Español oprima dos.

Quick Links

Copyright © 2016 NextLevelHealth Partners.
All Rights Reserved. 833-ASK-NLHP (833-275-6547)

To learn more about your health plan choices, visit EnrollHFS.Illinois.gov.