Why Choose Us?
We know it’s important for you to get quality care at the right place and time. With the Senior Whole Health Medicaid Managed Long Term Care (MLTC) Plan, your Personal Care Manager works with you to ensure you receive the personalized, comprehensive care and services you need so you can remain safe and healthy in the comfort of your home.
What benefits are included in the SWH of NY MLTC Plan?
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Covered Services
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Care and services provided in a residential health care facility or approved extension site must be provided:
• Under the medical direction of a physician
• By Adult Day Health Care staff
• Based on the member’s Comprehensive Needs Assessment and care plan
• With ongoing coordination of the health plan
Includes transportation.
Prior authorization required.Treatment and equipment to help you hear better. Hearing exams and hearing aids are provided by a network of local, independent audiologists in the SWH of NY service area. Every exam is performed by a fully licensed audiologist. If you think you need a hearing exam, we may ask you to see your doctor first to be sure that another health problem is not affecting your ability to hear. We also cover batteries for your hearing aids.
Prior authorization required.Services for members with chronic illnesses or physical disabilities who have a medical need for help with activities of daily living (ADL) or skilled nursing services. Includes any of the services provided by a personal care aide (home attendant), home health aide, or nurse.
You have flexibility and freedom in choosing your caregivers. You, or the person acting on your behalf, are responsible for hiring, firing, training, supervising and terminating, if necessary.
Prior authorization required.A service by a special type of provider that treats your teeth and gums. Dental services are provided by DentaQuest. You can contact them at 1-855-343-4272.
Your coverage includes:
• Annual oral examination and cleaning
• Medically-needed dentures, fitting and alignment (one full set every 4 years)
• Dental implants, subject to medical necessity*
*Prior authorization required for dental implants. Request must be accompanied by a physician’s letter explaining how the implants will help with your medical problem. The request must include a dentist’s letter explaining why other alternatives will not correct your condition and why you require implants.Items to help with your health care and to take care of yourself. DME includes medical/surgical supplies, enteral and parenteral formula, hearing aid batteries, prosthetics, orthotics and orthopedic footwear, canes, hospital beds, wheelchairs, oxygen, and walkers.
Prior authorization may be required for some equipment.Meals provided at home or in congregate settings, such as senior centers for individuals unable to prepare meals or have them prepared.
Prior authorization required.Services provided in your home. These services may be provided by licensed staff or unlicensed staff. Includes nursing, home health aide, occupational, physical and speech therapies.
Prior authorization required.Checking, setting up and giving help for social problems to keep you in your home. Services are performed by a qualified social worker and provided within a plan of care.
Prior authorization required.Products needed to take care of a medical condition. Usually these products are not re-usable by other people. New York Medicaid allows us to pay for compression and support stockings only when they are used venous or lymphatic impairment.
Prior authorization required.Includes non-emergency transportation to and from a medical appointment. To schedule transportation, call 1-855-558-1638 and follow the prompts. Transportation must be scheduled at least 3 (three) days before your appointment. You can schedule your transportation up to 30 days in advance.
Prior authorization required.Includes assessment of nutritional needs, development and evaluation of treatment plans, nutrition education and counseling. Includes cultural considerations.
Prior authorization required.A nursing home is a place for people who don't need to be in a hospital but can't be cared for at home. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
Some nursing homes are set up like a hospital. The staff provides medical care, as well as physical, speech and occupational therapy. There might be a nurses' station on each floor. Other nursing homes try to be more like home. They try to have a neighborhood feel. Often, they don't have a fixed day-to-day schedule, and kitchens might be open to residents. Staff members are encouraged to develop relationships with residents.
Some nursing homes have special care units for people with serious memory problems such as Alzheimer's disease. Nursing homes are not only for the elderly, but for anyone who requires 24-hour care. For SWH of NY to pay for nursing home care, you must be eligible to receive the nursing home care from Medicaid in New York.
Prior authorization required.Vision services include:
• Annual preventive eye exams
• Medically necessary eye exams
• Eyeglasses provided by network optometrists (must be medically necessary)
̶ Limited to one pair of glasses every 2 (two) years unless your prescription changes
For members who require both distance and reading correction, you may get one pair of each every two years
Prior authorization required.Shoes, shoe modifications or shoe additions which are used to correct, accommodate, or prevent a physical deformity or range of motion malfunction in a diseased or injured part of the ankle or foot.
Prior authorization required.Covered services include:
• Physical and occupational therapy
• Speech language therapy
• Cardiac rehabilitative therapy
• Social and psychological therapy
• Comprehensive Outpatient Rehabilitation Facility (CORF) services
Prior authorization required.Service to help you stay at home instead of going to a nursing home. Personal care includes services such as housekeeping, meal preparation, bathing, toileting, and grooming.
Prior authorization required.An electronic device that sends an alert if you are not safe or have fallen and cannot get up by yourself.
Prior authorization required.Care for your feet by a podiatrist (foot doctor). Foot care including initial examination, nail trimming and callous removal when medically necessary.
Prior authorization required.Must be provided by a registered professional nurse (RN) or licensed practical nurse (LPN) possessing a license and current registration from the NYS Education Department. Services may be provided through an approved certified home health agency, licensed home care agency or private practitioner.
Prior authorization required.Prosthetics are man-made body parts (other than dental) used to replace your missing body part(s).
Orthotics are special inserts for your shoes.
Prior authorization required.We will coordinate with your health care professionals on required medical equipment, supplies, respiratory therapy, and oxygen.
Prior authorization required.Social day care is set up as a safe place you can go to receive care and meet with others. Social day care services include time with other adults, supervision, personal care, and help with your nutrition. Some social day care facilities have more services and may include help for your caregiver, help with living skills, care coordination, and transportation.
Prior authorization required.Social supports are people and tools that help keep you in touch with other people.
Environmental supports are changes to your home that increase your ability to do things on your own or increase your ability to help with your care. Social and environmental supports include services such as home maintenance tasks, homemaker/chore services, housing improvement, and respite care.
Prior authorization required.