Tribal Consultation Letter
" Tribal Consultation Letter " is also available in Portable Document Format format (PDF, 48KB, 2pg.)
State of New York
Department of Health
The Governor Nelson A. Rockefeller Empire State Plaza
Albany, New York 12237
Nirav R. Shah, M.D., M.P.H. Commissioner
Sue Kelly, Executive Deputy Commissioner
April 15, 2011Mr. Clinton Halftown
PO Box 11
Versailles, NY 14168
Dear Mr. Cagey:
In July 1997, New York State received approval from the federal government of its Section 1115 waiver request, known as the Partnership Plan. Approval of this waiver allowed the State to implement a mandatory Medicaid managed care program in counties with sufficient managed care capacity and the infrastructure to manage the education and enrollment processes essential to a mandatory program. In 2006, New York State received federal approval for a second demonstration waiver, the Federal-State Health Reform Partnership (F-SHRP), under which the State implemented a significant restructuring of its health care delivery system.
New York State is requesting amendments to its two Section 1115 waiver programs (The Partnership Plan, 11-W-00114/2 and F-SHRP, 11-W-00234/2). These amendments are necessary to implement initiatives of the State's Medicaid Redesign Team (MRT) and changes in State law authorizing such implementation. Due to the unsustainable costs of the Medicaid 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. Two major MRT proposals require amendments to the waiver programs: Expand Medicaid Managed Care Enrollment and Mandatory Managed Long Term Care Plan Enrollment
The proposal to expand Medicaid managed care enrollment involves enrolling more high cost/high need populations into managed care in order to promote better care management and coordination of services. The State proposes to eliminate most of the existing exemption and exclusion categories and require enrollment over a period of three years according to the attached schedule. Program features necessary to support the enrollment of each population will be developed and implemented prior to the scheduled start date.
Mandatory managed long term care enrollment would require Medicaid beneficiaries who are age 21 and older, dually eligible and in need of community-based long term care services for more than 120 days to enroll into one of the managed long term care plan options available in the State to the extent such options are available in their social services district. Currently, the three program options available are Partially Capitated Managed Long Term Care (MLTC) program, the Program for All-Inclusive Care for the Elderly (PACE) or Medicaid Advantage Plus. Mandatory enrollment will begin in New York City and be phased in throughout the rest of the State as plan capacity is developed.
As you know, under the State's Section 1115 Demonstration programs, Native Americans with Medicaid coverage may enroll in managed care plans but are not required to do so. Under these amendments to the 1115 waiver, this exemption from mandatory enrollment for Native Americans will be continued. In addition, for Native Americans who choose to enroll in managed care plans, existing policies relating to tribal providers will be continued.
Additional information concerning the Partnership Plan and the proposal can be obtained by writing to:
New York State Department of Health
Bureau of Program Planning and Implementation
Empire State Plaza
Corning Tower, Rm. 1927
Albany, New York 12237
1115 waiver information is also available to the public on-line at: Medicaid Section 1115 Demonstration Projects
Director, Division of Managed Care