August 29, 2008

YOUR ATTENDANCE IS REQUESTED

Ask DOH all about Medicaid managed care next Wednesday
question%20mark.jpg
There are still unanswered questions about managed care

On Wednesday, September 3, at 1pm the New York State Department of Health invites stakeholders to a meeting at St. John's University about the now all-but-inevitable shift of people with HIV/AIDS on Medicaid into managed care. For full meeting details and to RSVP, click here to read the letter, signed by AIDS Institute Director Humberto Cruz and Director of the Division of Managed Care Jay Laudato.

"We welcome the opportunity for an open dialogue," the letter states. Although State Medicaid Director Deborah Bachrach explained to the Update how mandatory HMO will roll out, there are a multitude of concerns about how the process will affect the quality of care for people living with AIDS; how the capacity, standard and access to care will be developed for those not in Special Needs Plans; and how the current level of case management will be maintained.

Here are some suggested questions to ask the Department of Health on Wednesday:

  • Of the approximately 60,000 Medicaid recipients with HIV/AIDS, what percentage are certified disabled?

  • Of the approximately 60,000 Medicaid recipients with HIV/AIDS, what percentage are on medication regimens? Can the state Department of Health make sure this subset does not have interruptions in care, by guaranteeing payment for transitional care and/or establishing a "fall back" or default billing option?

  • What are the auto-assignment rates of chronically ill and disabled Medicaid recipients newly mandated into Medicaid managed care, as compared to that of the general population?

  • Can the state DOH sample newly enrolled SSI recipients' Medicaid service usage one year prior to enrollment and one year post-enrollment, compare usage and indicate the auto-assignment rate for the sample?

  • Can the state DOH release plan change data for newly enrolled SSI recipients?

  • What is the state DOH's plan for auto-enrollment as related to the traditional Mandatory population? Rates of auto-assignment normally go by plan quality scores. Medicaid recipients with HIV/AIDS cannot be auto-assigned on this basis because plans with highest quality for this population would be SNPs.

    • These questions aren't just hypothetical: They are based on the problems experienced when SSI recipients were shifted into mandatory managed care in 2005. There were a litany of failures, including interruptions in home care, failure to notify recipients of their auto-assignment to an HMO, and finding a plan that includes all of the specialists necessitated by a serious, chronic illnesses. Many PLWHAs on Medicaid also have concurrent chronic illnesses, and mental health and substance abuse problems.

    "Managed care as a theory can work if recipients understand how to use it, but there are so many different ways people can fall through the cracks," said Diane Spicer, a staff attorney at the Legal Aid Society. "Training, education and outreach is essential to make consumer and providers aware of all the changes. And the state department of health has a long way to go with Outreach to the community before they can mandate another disabled population."

    Based on the prior mistakes, advocates are developing standards that the State must have prior to the implementation of mandatory managed care for people with HIV.

    To sign on to a letter to Bachrach and Laudato outlining concerns with managed care rollout, contact terri smith-caronia at smith-caronia@housingworks.org.



    Email a link for this entry to a friend

    Email this entry to:


    Your email address:


    Message (optional):