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.
- 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