Member Eligibility

Participation in any of Senior Whole Health of New York's programs is voluntary.

Senior Whole Health of New York Medicare Advantage (HMO SNP) Medicaid Advantage PLUS — NHC Plan

To be eligible to enroll in Senior Whole Health of New York's NHC (HMO SNP) program, individuals must also be enrolled in Senior Whole Health of New York for Medicare coverage and:

  • Are age 65 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 their home and community without jeopardy to their 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 health care;
    • Private Duty Nursing;
    • Consumer Directed Personal Assistance Services.
  • Determined by the New York City Human Resources Administration Medicaid office (HRA) to be eligible for benefits under the Medicaid program.

SWH Whole Health FIDA Plan

To be eligible to enroll in SWH Whole Health FIDA Plan, individuals must be:

  • Age 21 or older;
  • Entitled to benefits under Medicare Part A and enrolled under Parts B and D, and receiving full Medicaid benefits;
  • Reside in a SWH Whole Health FIDA Plan Demonstration County: Bronx, Kings, New York or Queens counties;
  • Individuals must also meet one of the following three criteria:
    • Are clinically eligible to reside in a nursing home and are receiving facility-based Long-term services and supports (LTSS);
    • Are eligible for the Nursing Home Transition and Diversion Waiver (NHTD); or
    • Require community-based Long-term services and supports (LTSS) for more than 120 days.

Senior Whole Health of New York Managed Long Term Care Program

To be eligible to enroll in the Senior Whole Health of New York Managed Long Term Care Program, individuals must be:

  • At least 21 years of age
  • A resident of Bronx, Queens, Kings, New York or Westchester County
  • Determined eligible for Managed Long Term Care by Senior Whole Health of New York using an eligibility assessment tool designated by the State Department of Health
  • Capable at time of enrollment of returning or remaining in their home and community without jeopardy to their health and safety
  • 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 health care
    • Private duty nursing
    • Consumer Directed Personal Assistance Services
  • Determined by the New York City Human Resource Administration (HRA) Medicaid Office to be eligible for benefits under the Medicaid program

Last Updated 01/01/2018