MANDATORY MANAGED LONG TERM CARE

Major Change Starting in July, 2012

If approved by the federal government, beginning with New York City residents in July, 2012, (this has been changed from April 1) enrollment in Managed Long-Term Care plans will be mandatory for most adult Medicaid enrollees who need home and community based long-term care services for more than 120 days. People who are in the Assisted Living Program, Nursing Home Transition and Diversion waiver, Traumatic Brain Injury waiver and those served through the Office of People with Developmental Disabilities will be exempt from mandatory enrollment at this time. Although consumer choice will be encouraged, auto assignment will be put into place for those who do not choose a plan. Mandatory enrollment will expand throughout the rest of the state as care plans become available. In addition, in October 2012, Medicaid nursing home residents will be required to enroll in a managed plan and all plans will begin covering nursing home placement. Thus, individuals researching the plans they want to enroll in must carefully look at the nursing homes in the plan's network of providers to make sure that these are the homes they would want to go to if they needed institutional care.

This is a major change. In the past, enrollment in managed long term care plans has been voluntary. Now eligible individuals will either choose a plan or, if they do not choose, be enrolled in a plan chosen by the state. Enrollment will be phased in over time, beginning with Manhattan in April. New York State expects to enroll 2,000 people a month into the plans.

Change for Dual Eligibles

People eligible for both Medicaid and Medicare who need home and community based long-term care services for more than 120 days will be required to enroll in a managed long term care plan that includes both Medicare and Medicaid services. If CMS approves the state's proposal, DOH will begin mandatory enrollment of these dual eligibles in New York City, Nassau, Suffolk and Westchester in January, 2014.

State Wants to Save Money: Creates Medicaid Redesign Team (MRT)

This initiative is part of the state's desire to save money. In a letter to the federal government asking for approval to mandate enrollment in managed long term care plans, the Department of Health stated, "Due to the unsustainable costs of the Medcaid (sic) program Governor Cuomo commissioned the MRT to redesign the provision of services in order to contain costs, create efficiencies, and improve the quality of care provided to over 4 million New York State residents." The Governor created a Medicaid Redesign Team to "redesign" Medicaid and implement cost savings passed in the last budget. There are few consumers or their representatives on the Team. Of the 24 members, only two are considered consumers although one of these consumers represents both consumers and providers. Six of the members are providers or representatives of provider organizations; three represent unions; four are legislators; eight represent local and state governments; and one is a private insurer. Ten committees were formed to focus on specific issues.

LTCCC Makes a Statement to MRT

LTCCC's executive director makes a statement to the full MRT and states that "We recognize that the financial crisis of the last few years has put unprecedented pressure on NY to lower healthcare and other expenses. While we understand that the state must respond to the crisis, we are deeply concerned by the prospect of it proceeding with insufficient meaningful public input in the process and, ultimately, that the state will balance its budget on the backs of the poor and middle class and, most worrisome, on the backs of the frail elderly and disabled. They are among our most vulnerable citizens and are the communities most likely to depend on long term care services and supports. Yet, rather perversely, they are often provided the least opportunity to make their voices heard in these processes." Click on the link above to read the whole statement.

LTCCC Is Focusing on Managed Long Term Care Work Group Recommendations

With a grant from the Robert Sterling Clark Foundation, LTCCC is focusing on one of Work Groups: the Managed Long Term Care Implementation Work Group. The charge of this Work Group is to: (1) Advise DOH on the development of care coordination models to be used in the mandatory enrollment of persons in need of community-based long term care services; (2) Review processes to ensure that sufficient patient protections exist; (3) Promulgate guidelines for network development and contractual arrangements which are sufficient to ensure the availability, accessibility and continuity of services.; and (4) Discuss ways to promote access to services and supports in homes and communities, so individuals may avoid nursing home placement and hospital stays. To follow the progress of full MRT, see http://www.health.ny.gov/health_care/medicaid/redesign/. To follow the progress of the Managed Long Term Care Work Group, see http://www.health.ny.gov/health_care/medicaid/redesign/managed_ltc_workgroup.htm.

Draft Recommendations Released in November: LTCCC Responds

This Work Group released its recommendations in November. LTCCC sent a letter commenting on these recommendations. Click here for a copy of this letter. Among our comments:

1. There should be mandated qualifications for the care manager or team.

2. DOH should develop guidelines for a ratio of care managers to members.

3. Requiring plans to have "adequate capacity" to serve must be spelled out.

4. Adequate consumer choice means more than two providers (where available).

5. Criteria for plans to collect must be uniform so consumers can compare plans.

6. Development of reliable quality data for plan collection is crucial. However, DOH must have adequate resources to monitor quality.

7. Individuals needing nursing home care must be able to go to any nursing home of their choice, not just the one or two in their network.

In a telephone conference with DOH staff, LTCCC made the following comments:

1. Thirty days to choose a plan may not be enough time.  DOH has changed this to 60 days.

2. Will DOH be able to develop educational materials in time for April roll out?  DOH has changed the start date to July.

3. Members needing nursing home placement should be able to change plans if they do not want to go the one or two homes in the plan.

4. DOH is already understaffed; how will it be able to monitor care and handle complaints?

Future LTCCC Activities

When the full MRT releases its final report, LTCCC will analyze the report to see whether it successfully meets the goals of the Managed Long Term Care Work Group which were, among other things, to develop approaches to care coordination and management that would have the most beneficial impact on beneficiaries, service use and Medicaid expenditures by ensuring patient rights, protections and access; improving the care and outcomes of the target population; monitoring of performance; and a voidance of nursing home placement and hospital stays.

Updated: February 16, 2012