PACE and MLTC are both Medicaid programs that help New Yorkers get long-term care at home, but they work differently. PACE is an all-inclusive plan for people 55 and older who need a nursing home level of care, and it delivers everything, including doctors, through its own care team. Managed Long Term Care (MLTC) plans manage home care and related long-term services, and in some types you keep your current doctors.
What is the difference between PACE and MLTC?
The New York State Department of Health treats PACE as one of three lines of business inside the MLTC program. The state’s MLTC page describes them this way:
| MLTC Partial Capitation (MLTCP) | Medicaid Advantage Plus (MAP) | PACE | |
|---|---|---|---|
| Minimum age | 18 (a few plans 21) | 18 | 55 |
| Coverage you need | Medicaid | Medicaid and Medicare | Medicaid (Medicare too if you have it) |
| What it covers | Home care and other long-term services, plus up to 3 months of nursing home care | Integrated care: primary care, acute, behavioral health and long-term care | All medically necessary primary, acute and long-term care |
| Your Medicare | Stays separate | You join the plan’s matching Medicare Advantage plan | Your Medicare services come from PACE |
| Doctors | Keep your Medicare doctors | Choose a primary care doctor in the plan’s network | Use the PACE team and its network |
The state’s plan-choosing guide says MLTC Medicaid plan members can keep seeing their Medicare doctor, MAP members choose a primary care physician from the plan’s network, and every MLTC plan assigns a care manager who builds your plan of care. Medicare.gov says that when you join PACE you must use providers in the PACE organization’s network.
| If this matters most to you | Look at | Why |
|---|---|---|
| Keeping your current Medicare doctors | MLTC partial plan | The state’s guide says members can keep seeing their Medicare doctor. |
| One plan for Medicare, Medicaid and drugs | MAP or PACE | Both list Medicare Part D drug benefits among their services. |
| A day center and a full care team | PACE | PACE members receive services from the PACE team, including at the day center. |
| Freedom to change plans | MAP or PACE | Members may ask to transfer at any time, subject to Medicare restrictions. MLTC partial plans have a 9-month lock-in after the first 90 days. |
Who qualifies for each?
All three require that you are assessed as needing community-based long-term care for more than 120 days. After that, the rules split:
- MLTCP and MAP: you must meet the Minimum Needs Requirement, meaning at least limited assistance with physical maneuvering for more than two activities of daily living, or, with a dementia or Alzheimer’s diagnosis, at least supervision with more than one.
- PACE: you must be 55 or older, live in the plan’s service area, need nursing home level of care, and be able to remain safely at home or in the community. The state says the Minimum Needs Requirement does not apply to PACE enrollment.
The state’s PACE eligibility list includes having Medicaid. Medicare.gov adds that people without Medicaid can sometimes pay the PACE premium themselves, so ask the PACE plan about your situation. Our guide to CDPAP eligibility explains the same Minimum Needs Requirement in more detail.
You may also be required to join. The state’s guide says people aged 21 and over with both Medicare and Medicaid who receive home care or adult day health care for more than 120 continuous days must join an MLTC plan when New York Medicaid Choice tells them to. If you do not choose, a plan will be chosen for you. People in an Assisted Living Program or receiving hospice services cannot join.
Which plans serve Brooklyn and Queens?
The state’s plan directory shows plenty of choice for MLTCP and MAP and just one PACE option:
- MLTC partial plans: ten plans list both Kings (Brooklyn) and Queens, plus Fidelis Care at Home, which covers the whole state.
- Medicaid Advantage Plus: eleven plans cover both boroughs.
- PACE: CenterLight Healthcare PACE is the only PACE organization on the list that serves Kings and Queens.
Plans and service areas change, so check the directory for current listings and each plan’s own provider directory before you decide. New York Medicaid Choice offers free enrollment help at 1-888-401-6582 (TTY 1-888-329-1541) and can check which plans work with the doctors and agencies on your list.
How do you choose a chronic care management provider in NYC?
“Chronic care management” can mean two different things, and mixing them up is common.
First, Medicare has a billable service called Chronic Care Management (CCM). Under the Centers for Medicare & Medicaid Services’ CCM booklet, it is for patients with two or more chronic conditions expected to last at least 12 months. It involves a comprehensive care plan, 24/7 access to a care team member, and your consent. Only one practitioner can bill CCM in a month, and cost-sharing can apply. This is something your own doctor’s office offers, not a plan you join.
Second, PACE and MLTC plans manage chronic conditions as part of long-term care, with a care team or care manager. Here is a practical way to choose:
- List the conditions, medicines and appointments that matter most, and which doctors you want to keep.
- If you only need help organizing medical care, ask your primary care practice whether it offers CCM and what it would cost you.
- If you also need daily help at home and have Medicaid, compare MLTCP, MAP and PACE using the table above.
- Call New York Medicaid Choice with your provider list to see which plans fit.
- Ask each plan how it handles after-hours calls, who your care manager would be, and which home care agencies it works with.
What care options exist for insulin-dependent seniors?
For someone on insulin, the main difference between plan types is how medications and monitoring are covered. The state’s guide lists Medicare Part D drug benefits among MAP and PACE services, while an MLTC Medicaid plan stays separate from your Medicare. Medicare.gov says PACE covers prescription drugs and that joining a separate Medicare drug plan would disenroll you from PACE.
Under Original Medicare, Part B and Part D together cap insulin at no more than $35 for a one-month supply of each covered insulin product. The American Diabetes Association’s 2026 Standards of Care recommend continuous glucose monitoring for older adults with type 2 diabetes on insulin, who face a greater risk of low blood sugar. If monitoring matters, ask any plan which devices and supplies it provides and who helps with the routine. Our guide to diabetes care at home has more on day-to-day support.
What do home care aides earn under these plans?
Families often ask because pay shapes who is available to work. The state’s minimum wage for home care aides is $19.65 an hour in New York City in 2026 and $20.00 from January 1, 2027, whatever plan covers the care. For the full breakdown, see our guide to HHA and PCA pay in NYC.
How many hours of home care will an MLTC plan approve? A note from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
I never promise a family a number of hours before the assessment. Two people with the same diagnosis can need very different amounts of help. The assessment looks at how they manage daily activities, their cognitive state and other individual needs. If the approved hours still look too low, ask for a reassessment.
Don’t wait for a hospital stay or a fall to start looking at Medicaid and home care programs. It is far easier to arrange safe care before things reach a crisis.
How do you switch plans or challenge a decision?
The state’s guide spells out the rules. MAP and PACE members may ask to transfer at any time, subject to Medicare restrictions. An MLTC Medicaid plan has a lock-in: you can change plans for any reason during the first 90 days, then not for the next 9 months without a good reason. If you qualify, you can move to MAP or PACE at any time.
If a plan denies, reduces or ends services you think you need, you can appeal, and your member handbook explains the right to a Fair Hearing. You can also call New York Medicaid Choice at 1-888-401-6582 or the Department of Health at 1-866-712-7197. For an overview of what Medicaid covers, see what Medicaid covers for home care, and for help judging agencies, see how to choose a home care agency.
We are a licensed home care agency in Brooklyn and Queens, NY State Department of Health licence #2572L001. We cannot enroll you in a plan, but we can explain what each means for daily care and work with your plan once you have chosen. Call (718) 232-2777 or use our contact page.
Program rules and plan lists change. Everything above was checked on 9 October 2026 against the New York State Department of Health, Medicare.gov and CMS pages linked in the text. Confirm your own eligibility and plan options with New York Medicaid Choice before you enroll.
Frequently asked questions
What is the main difference between PACE and MLTC?
PACE combines Medicare and Medicaid services, including primary care, under one plan with its own care team, for people 55 and older who need nursing home level care. MLTC plans in the other two lines manage Medicaid long-term services such as home care, and in the partial plan your Medicare stays separate.
Can I keep my own doctor in PACE?
Generally not. Medicare.gov says PACE members must use providers in the PACE organization’s network, though PACE can contract with outside specialists. In a partial MLTC plan you can keep your Medicare doctors, and in MAP you choose a primary care doctor in the plan’s network.
Is there a PACE plan in Brooklyn and Queens?
The state’s directory lists CenterLight Healthcare PACE as the PACE organization serving Kings and Queens counties. Check the directory for current service areas before you rely on this.
How much does PACE cost?
Medicare.gov says people with Medicaid pay no monthly premium for PACE, and there is no deductible, copayment or coinsurance for care the PACE team approves. People with Medicare but not Medicaid pay a monthly long-term care premium plus a Part D premium.
Do I have to meet the Minimum Needs Requirement for PACE?
No. The Department of Health says the requirement does not apply to PACE enrollment. You do need to be assessed as needing nursing home level care and need community-based long-term services for more than 120 days.
Is chronic care management the same as PACE?
No. Chronic Care Management is a monthly Medicare service from a doctor’s office for people with two or more chronic conditions. PACE is a full health plan that also provides long-term care and delivers all your services.
Which option is better for someone on insulin?
None is better for everyone. MAP and PACE include drug coverage under the plan, while a partial MLTC plan leaves your Medicare drug plan separate. Ask each plan how it covers insulin, glucose monitoring supplies and who supports daily monitoring at home.
