Can I Leave the Program?
Yes. Enrollment is voluntary and as such you may initiate disenrollment at any time verbally or in writing, or by enrolling in another Managed Care Plan. If your disenrollment is due to a complaint or concern, please contact Senior Whole Health of New York. We value your membership and would appreciate an opportunity to address and resolve your dissatisfaction with the program.
All requests to voluntarily disenroll may be initiated with a verbal or written request to Senior Whole Health of New York. If you enroll in another Managed Care Plan, your disenrollment from Senior Whole Health of New York will be automatic.
If you are in a mandatory county, you may need to pick another MLTC plan by contacting New York Medicaid Choice at 1-800-505-5678.
If you wish to disenroll and still require long term care services you must join another MLTC or waiver program or, if you are Medicaid only, join a managed care plan. You cannot receive long term care services through Medicaid Fee for Service.
If you require continuation of Medicaid covered services upon your disenrollment from Senior Whole Health of New York, your disenrollment date will be effective on the first day of the month after all the services you request are coordinated by NYMC and in place.
If you do not require continuation of Medicaid covered services and you notify Senior Whole Health of New York that you wish to disenroll by the 10th day of the month, your disenrollment will be effective on the first day of the next month.
You will receive written notification of the date of your disenrollment. Senior Whole Health of New York will continue to provide or arrange for the provision of covered services to you until the effective date of your disenrollment. We will also assist with the transfer to new service providers.
Can I Be Asked to Leave the Program?
Disenrollment may not be based on deterioration, worsening of your health, or cost of your covered services.
You must be disenrolled if:
You join another Managed Care Plan capitated by Medicaid (i.e. Hospice, a home and community based services waiver program, OMRDD Day Treatment)
You move out of the service area;
You leave the service area for more than 30 consecutive days;
You are hospitalized or enter an OMH, OPWDD or OASAS residential program for 45 consecutive days or longer;
You are admitted to a Skilled Nursing Home and are not eligible for Institutional Medicaid;
Your Medicaid is terminated;
You are no longer eligible for nursing home level of care, and terminating plan services will not cause your condition to deteriorate in the next six (6) months;
You are incarcerated.
You may be disenrolled if:
You or others in your home exhibit abusive, disruptive or uncooperative behavior to such a degree as to jeopardize the provision of care;
You have failed to pay your spend-down within thirty (30) days;
You or your family provide the program with false information or engage in fraudulent conduct;
You knowingly fail to complete and submit requested documentation;
Your physician refuses to collaborate or cooperate on developing and implementing the plan of care and you do not wish to change physicians.
Senior Whole Health of New York will work with you to attempt to resolve these issues. If the issues are not resolved, then we will notify the NYMC of request for disenrollment. NYMC must agree with any involuntary disenrollment, and will send written notification of such to you. Senior Whole Health of New York will continue to provide or arrange for the provision of the covered services to you until the effective date of your disenrollment. Program personnel will assist you with arrangements for future services from another provider. In order to prevent a lapse in delivery of services to you, services from the new provider will be effective on the date of disenrollment from Senior Whole Health of New York. The time frame for the effectiveness involuntary disenrollment is the same as for voluntary disenrollment.
Last Updated 01/26/2016
NYS DOH Approved 01/27/2016