November 27, 2007

HIV HMO NIGHTMARE?

This might hurt a little...

A decade ago, State and City officials tried to force Medicaid beneficiaries into substandard Medicaid HMOs that weren't ready to provide quality care for New Yorkers with HIV/AIDS—or even particularly interested in talking to them.

Now the Spitzer administration (which is smarter on health care and HIV than the previous administration, but potentially problematic on hot-button AIDS issues) has hired high-paid consultants to come up with new recommendations on the issue. In a just a few weeks, Spitzer could try to change state laws to impose mandatory managed care for people with HIV/AIDS during next year’s legislative session in Albany.

A great way to get informed about this sure-to-be front-burner political and health care issue is to attend a special community meeting this Thursday afternoon, hosted by Federation of Protestant Welfare Agencies (FPWA), New York AIDS Coalition (NYAC), Gay Men's Health Crisis (GMHC) and Housing Works, along with other HIV/AIDS advocates:

For more information about the event, click here.

The proposed shift could bring complex conflicts of interests between Medicaid beneficiaries, community-based service providers, AIDS organizations, and managed care networks. It's unclear if mainstream HMOs are ready to provide good HIV care. It's unclear if they are ready or willing to negotiate real-world contracts with community-based AIDS care providers. And it's unclear whether specialized AIDS HMOs like HIV Special Needs Plans(SNPs) are big enough or strong enough to do the job alone.

The Housing Works position is clear: While managed care might make sense for some or even many people, it should never be mandatory. We'll be fighting to keep managed care optional, not mandatory, for beneficiaries living with HIV—that's their right under current law and it should stay that way.

But Thursday's public meeting should include a broad spectrum of perspectives from top-quality organizations like FPWA, NYAC, GMHC and The Legal Aid Society—it’s important to be there as this decade’s battles begin.