August 1, 2008
READY OR NOT...
even if DOH won't confirm
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…here Medicaid managed care comes flickr.com/photos/athena1970/1641655879/ |
During a New York State AIDS Advisory Council call last Wednesday, the Department of Health (DOH) discussed logistics of the switch for people with AIDS on Medicaid to mandatory managed care. DOH hasn't made an official announcement, but sources who were on the call say that despite lip service to community input, Medicaid managed care is going to happen, possibly as early as January 2009. The DOH had long said that any such shift would happen one borough a year for five years.
"It was all kind of a surprise that they are moving so quickly," said Dr. Lambert King, Director of the Department of Medicine at the Queens Hospital Center, who is on the AIDS Advisory Council and was one of the few members able to make the hastily arranged call. King said that the DOH indicated on the call that it would come up with a plan this week or next week and would solicit community input.
The DOH also stated on the call that they have been working on a mandatory enrollment proposal for people with HIV since 1994. And that's true, but the plan was halted after Housing Works issued several reports on poor enrollment practices when the majority of people on Medicaid were forced into the mainstream plans. At a Medicaid community meeting in May, state officials said they have learned from these experiences and have also learned from the more recent mandatory enrollment of SSI recipients in the plans.
Unanswered questions
So far DOH has been less than forthcoming about their plans. Neither State Medicaid Director Deborah Bachrach nor AIDS Institute Director Humberto Cruz would comment for the Update. 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. The DOH said it is working to get out data before the end of the week.
"Managed care has a mixed history for people with chronic illnesses, and there ought to be a full discussion of quality of care issues," said Jeffrey Reynolds, Public Affairs Advisor for the Long Island Association for AIDS Care. Reynolds, who is on the NYS Advisory Council but was unable to participate in last week's conference call, added, "I'm concerned about how this relates to the governor's talk about the fiscal position of the state. I'm sympathetic, but it shouldn't come at the expense of our clients."
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. While people can currently shift between plans if they are dissatisfied, a shift to mandatory managed care would lock consumers into a plan after three months for the rest of the year.
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.
"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," King said.