Consumers in NYC, Nassau, Suffolk and Westchester through different forms of Medicaid Managed Care. Dual eligible consumers (meaning they have both Medicare and Medicaid) must first enroll in a Managed Long-Term Care (MLTC) plan in order to receive care under the Consumer Directed Personal Assistant Service. Consumers with just Medicare must be enrolled in a mainstream managed Medicaid plan. In both cases, the Consumer Directed Personal Assistant Service is administered by the plan.