Letter of Intent Regarding Dual Eligible Demonstration Project, September 30, 2011

September 30, 2011

Melanie Bella
Medicare Medicaid Coordination Office
Centers for Medicare and Medicaid Services
200 Indepdenence Avenue, SW, Room 315H.1
Washington, DC 20201

New York State is submitting this letter of intent pursuant to the State Medicaid Director SMDL#11-008 letter dated July 8, 2011. We are interested in this partnership opportunity that will help meet the Cuomo administration goal of moving all Medicaid beneficiaries into managed care or care management within three years. An important element of this goal is the approximately 700,000 persons in New York who have both the Medicare and Medicaid benefits. This group of dual eligibles (duals) contains many of the high cost, complex cases. We have reviewed the guidance in the letter and have decided to pursue both the capitated and managed fee for service models at this time.

As you may know the governor was able to secure legislative authorization to move persons who are in need of community- based long term care services for at least 120 days into managed long term care plans or other care coordination models where there is sufficient plan capacity. This move is slated to start April 1, 2012 assuming we get CMS approval. The capitated model will be our primary approach for the dual population starting in the geographic areas where we have current managed long term care plan capacity. This area is the 5 boroughs of the City of New York where we already have seven Managed Long Term Care plans participating in our Medicaid Advantage Plus program. This program could serve as a starting point for full integration since it already covers both Medicare and Medicaid benefits including all long term care services. We welcome the opportunity to partner with you to grow plan capacity within and outside the City of New York.

Outside of the City of New York, the state is interested in both the capitated and managed fee for services models. Our strategy in areas of the state lacking MLTC capacity will be somewhat more flexible and we welcome your ideas and support for creative thinking while still meeting the goal the care management for all within three years.

We intend to use the platform of MLTC and mainstream managed care to integrate primary, acute, behavioral health and long term care supports and services and our target implementation date for starting is April 1, 2012. The implementation will be phased over at least a 24 month period dependent on numerous factors.

Thank you for your consideration. New York staff look forward to significant collaboration with CMS to address the necessary administrative activity, data sharing, and fiscal analysis that is necessary to have a successful integration for the 700,000 duals in New York.



Jason A. Helgerson
Medicaid Director
Deputy Commissioner
Office of Health Insurance Programs