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The Moving Parts of Medicaid Reform
CDPAANYS Annual Conference October 24, 2012
Presenter: Cathy Roberts, Senior Paralegal Empire Justice Center, Albany, NY
Mainstream managed care expansion
– Mandatory managed care expanding to all counties by 2013
– Fewer people qualify for exemption• i.e., even nursing home residents (non-duals) will be
required to enroll 10/13– More services in managed care package• Personal care• Prescription drugs• Dental• Consumer directed personal care
Integration of Care for Dual Eligibles:
MLTCFIDA
Health Homes
Managed long term care (MLTC)
– Applies to: dual eligibles (on Medicare and Medicaid) age 21 and over AND receiving 120 days or more of community based
LTC services in a calendar year. Over the next two years, they may be required to
enroll in a MLTC plan, depending on where they live.
Roll-out schedule (anticipated)
NYC (actual timetable) July 2012 – January 2013
Nassau, Suffolk, Westchester: January 2013
Rockland, Orange: June 2013
Albany, Erie, Onondaga, Monroe December 2013
Other counties with capacity June 2014
What about integration of non-LTC services?
NYS DOH seeking demonstration waiver, using two-pronged approach:
FIDA (Fully Integrated Dual Advantage) Managed care model All Medicare/Medicaid services provided
through FIDA plan Health homes
Managed fee for service system Care management service model
Health home and FIDA enrollment process
Passive enrollment with “opt-out” provision People will be automatically enrolled
They can decline the enrollment altogether, or choose a different FIDA or health home
•
Enrollment broker can assist with FIDA plan choice and enrollment
Timeline - FIDA FIDA managed care
Who? Full duals age 21+, need more than 120 days
of LTC, not in mental health facility Special FIDA plans for OPWDD
beneficiaries Where?
NYC, Nassau, Suffolk, Westchester (regular FIDA)
Statewide (OPWDD FIDA) When?
Jan 1 2014
Timeline - Health homes Who?
Full duals age 21+, not in mental health facility, don’t need 120+ days of LTC services, AND meet ONE of the following criteria: Two chronic conditions Serious mental illness Have HIV, are at risk of developing
another chronic condition Where?
Statewide When?
Ongoing
Advocate Concerns Complexity of Enrollment Choices Continuity of care during transition High need clients getting proper level of
care Loss of benefits
Davis v. Shah (Empire Justice, shoes & stockings) Johnson v. Shah, Strouchler v. Shah (NYLAG, home
care) Reporting and state oversight
Promising Changes New housing allowance for Medicaid recipients
: Returning to the community after 30+ days at a
skilled nursing facility Enrolling (or enrolled) in a managed long term care
program Centralization/Automation
Renewals in Medicaid/ Medicare Savings Programs Spend down activation
Health homes? New enrollment system for State Health
Insurance Exchange? (www.ux2014.org)
Links to more info DOH webpage on Medicaid Redesign
www.nyhealthacccess.org
My contact information:
Cathy Roberts, Senior Paralegal
Empire Justice Center
119 Washington Avenue
Albany, NY 12210
1-800-635-0355 x 112
www.empirejustice.org
