Who Can Join?

Senior Whole Health of New York NHC (HMO SNP) is a program for people who have both Medicare and Medicaid. You are eligible to join if you are also enrolled in Senior Whole Health of New York for Medicare coverage and:

  • Are age 18 and older;
  • Reside in the plan's service area: Bronx, Kings, Nassau, New York, Queens, and Westchester counties;
  • Medically eligible for nursing home level of care, as of the time of enrollment;
  • Capable at time of enrollment of returning or remaining in your home and community without jeopardy to your health and safety; AND
  • Assessed as requiring at least one of the following long term care services and care management for more than 120 days from the effective date of enrollment:
    • Nursing services in the home;
    • Therapies in the home;
    • Health Aide services in the home;
    • Personal care services in the home;
    • Adult day healthcare;
    • Private Duty Nursing;
    • Consumer Directed Personal Assistance Services.
  • Determined by the New York City Human Resources Administration Medicaid office (HRA) or your Local Department of Social Services (LDSS) Office to be eligible for benefits under the Medicaid program.

Denial of Enrollment: You will be denied enrollment to Senior Whole Health of New York NHC (HMO SNP) if:

  • You do not meet the eligibility criteria listed above.
  • You are diagnosed with End-Stage Renal Disease (ESRD). However, if you develop ESRD while a member of Senior Whole Health of New York NHC (HMO SNP) you can stay in the program.
  • You cannot be maintained safely in your home.
  • You do not need long term care services of the plan for more than 120 days.
  • You are enrolled in one of the following: Another Managed Care Plan capitated by Medicaid, a Home and Community-Based Services waiver program, a Hospice, a State Office for People with Developmental Disabilities (OPWDD) facility or waiver program and do not want to disenroll.

Last Updated 04/22/2020