Long-Term Care benefits
The Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program provides services and supports to people who qualify for Medicaid nursing home placement. It includes long-term care services to help you live at home or in setting that you choose. You may be eligible to enroll in the plan if you:
- Are age 18 or older
- Are eligible for Medicaid
- Have had a review by Comprehensive Assessment and Review for Long-Term Care Services (CARES) to decide your eligibility
- Live in our service area
What you get with Simply
We help you get the services and supports you need for everyday living. You will get a personal case manager who will work with you, your loved ones and your providers to make a plan of care.
Plan of care
Covered long-term care services
If you live in an assisted living facility, adult family care home or nursing home, there may be a room and board or patient responsibility cost. There are no costs for other covered services.
- Adult companion care
- Adult day health care
- Assistive care services
- Assisted living services
- Attendant care services
- Behavioral management
- Care coordination/case management
- Caregiver training
- Home accessibility adaptation
- Home-delivered meals
- Homemaker services
- Hospice services
- Intermittent and skilled nursing
- Medical equipment and supplies
- Medication administration
- Medication management
- Nursing facility services
- Nutritional assessment/risk reduction services
- Occupational, physical, respiratory and speech therapy services
- Personal care services
- Personal Emergency Response System (PERS)
- Respite care
- Transportation (nonemergency)
These services require prior authorization (approval) before you can get them. Your plan of care will have all the services you and your case manager decide on. Your case manager will get approval for your services.
You’ll keep getting your primary care services from your Medicare or Medicaid plan.
We offer extra benefits just for our Simply members.
For up to 30 days for members in assisted living facilities or adult family care homes
Cellphone and monthly minutes
Free cellphone with free monthly minutes, data and text messages
Nursing home transition fund
Up to $5,000 toward costs for moving to a home or community setting. Funds can help pay for:
- Security and utility deposits
- Household furnishings
- Moving costs
Understanding case management
Your case manager
You’ll have your own case manager who will talk to you, your caregivers and your providers about the services you need. Your case manager will help coordinate all of your services.
Your plan of care
You’ll get a plan of care designed just for you. You and your case manager will work together to figure out the care and services you need to help you meet your health care goals. Your case manager will look at your:
- Health needs
- Home setting
- Support from family and friends
When your needs change, your case manager will look at what has changed and make changes to your plan of care.
Your case management team
Your case manager is part of a team who can help with:
- Finding personal care aides and homemakers
- Coordinating with home health agencies
- Finding assisted living facilities and nursing homes
- Getting rides to your appointments
- Making a back-up plan for possible gaps in service
Need to speak with your case management team?
Call 1-877-440-3738 (TTY 711) and ask for your case management team. Your team is available Monday through Friday from 8:30 a.m. to 5 p.m.
Your Care Plan is a tool for Simply Case Management members to help you:
- Stay connected with your care coordinator
- Get your care coordinator’s phone number and email address
- Send secure messages about diagnoses, goals, medicines, services and more
- View your goals and objectives
- Check due dates and statuses of goals and objectives
We want you to understand your benefits and receive the best possible care. Here are some resources to help.
Complete benefit information can be found in your member handbook.
If you have any questions, call Member Services at 1-877-440-3738 (TTY 711). Our team is available Monday through Friday from 8 a.m. to 7 p.m. You can also log in to your account to send us a message at any time.
24-hour Nurse HelpLine
Whether it’s 3 a.m. or a Sunday afternoon, health issues come up. That’s why you can always call our 24-hour Nurse HelpLine and speak directly to a nurse. Call 1-877-440-3738 (TTY 711) anytime, day or night.
Not yet a member? Choose Simply.
You have a choice in your health care. Choose Simply for dedicated case managers to coordinate your care and extra benefits to help you live a healthier life.How to enroll