July 25, 2008
GUV'S OFFICE LIKELY TO APPROVE MANDATORY MEDICAID MANAGED CARE FOR PEOPLE WITH HIV/AIDS
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Bachrach pushing for mandatory managed care for PWAs on Medicaid |
Despite the fact that state Medicaid Director Deborah Bachrach told the Update in May that mandatory managed care for people with HIV/AIDS on Medicaid was not a done deal, talk within the Department of Health, the AIDS Institute and the Governor’s office suggests that we could see mandatory enrollment begin as soon as this coming January. On Wednesday, state officials presented the proposal to members of the New York State AIDS Advisory Council.
If the State's plan goes through, current regulations will be changed and New Yorkers on Medicaid who are living with HIV/AIDS will be forced to enroll in a managed care plan. Mandatory HMO enrollment will undoubtedly save the state money, but it's unclear if health outcomes will improve. Key pieces of government information have yet to be made public, including a "three system analysis" that looked at outcome indicators for people living with HIV/AIDS enrolled in the current mainstream plan, those enrolled in HIV Special Needs Plans, and those remaining in the fee-for-service system. Bachrach and AIDS Institute Director Humberto Cruz claim that the data from this and other departmental reviews indicate that mandatory enrollment would improve quality of care.
Currently, PLWHAs on Medicaid have three health care choices: Fee-for-service care, including Designated AIDS Care Centers (or DACs, hospital-based programs founded in 1986 to provide quality care at a time when people with AIDS were ignored or abused in the typical hospital-based setting); HIV Special Needs Plans (or SNPs, specialized HIV HMOs created in 2003 as an experiment in providing HIV care with experienced providers in a managed care setting); and standard Medicaid HMOs.
It’s not clear that current managed care programs have the network capacity to meet access standards required for people living with HIV/AIDS. It’s also not clear if mainstream HMOs will be required to work in partnership with community-based AIDS care providers to provide high-quality HIV care or whether SNPs are ready for an influx of patients.
The only three existing SNPs—VidaCare, MetroPlus, and New York-Presbyterian System SelectHealth—are based in New York City. In May 2008, they served 3,070 people. (Ironically, while the SNPs were set up in anticipation of the possibility of mandatory enrollment, the AIDS Institute has determined that it would be a breach of confidentiality to auto-assign HIV-positive Medicaid patients to the SNPs. Consequently, those most in need of the intensive care that the SNPs provide are least likely to find their way into that system.)
Opposing mandatory enrollment
Housing Works is a part owner of VidaCare, which could stand to benefit significantly from implementation of mandatory managed care. Nonetheless, Housing Works strongly opposes coercion of people with HIV into managed care systems. Housing Works President and CEO Charles King has stated publicly that even if the concerns regarding capacity, access and quality of care are all addressed, Housing Works remains opposed to mandating this mode of care.
“We have invested in VidaCare because we strongly believe that the type of all-inclusive care that a SNP has the potential to provide is the best care for many people. But if managed care is so good, we shouldn't have to force people into it," King said. "Low income people living with HIV and AIDS act in their best interests based on the information they have. People with AIDS and HIV would be better served if the Department of Health focused on expanding the concept of all-inclusive care and then educated consumers to the benefits that care affords."
Housing Works' opposition to mandatory enrollment has been long-standing, including issuing several reports on poor enrollment practices when the majority of people on Medicaid were forced into the mainstream plans. State officials say they have learned from these experiences and have also learned from the more recent mandatory enrollment of SSI recipients in the plans. "Why, when it comes to poor people in New York, do we force them into a plan, but everyone else can choose?" King said at a May meeting on Medicaid in New York, earning cheers from attendees. "Unless we're going to single-payer health care, I don't believe poor people should be treated differently than anyone else."