31 New York Counties Receive Federal Approval for Mandatory Medicaid Managed Care
Albany, March 18 – State Health Commissioner Barbara A. DeBuono, M.D., announced today that New York has received approval from the federal government to move ahead with mandatory enrollment of certain Medicaid clients in managed care in 31 upstate counties. (See attached list of approved counties).
"This waiver approval represents a first step in achieving the State's goal of a mandatory managed care program providing access to primary care for all Medicaid recipients," Commissioner DeBuono said. "While we are still negotiating with the federal government for approval of our request to implement a statewide mandatory Medicaid managed care program for New York State, this will allow 31 counties to begin the process of implementing county–wide mandatory programs for some Medicaid recipients."
The federal Health Care Financing Administration has granted approval of Section 1915–b waivers filed by the State Health Department in August, 1996, on behalf of interested upstate counties. The federal action allows approved counties to require managed care enrollment for persons receiving Medicaid benefits under the Aid to Dependent Children (ADC) program and children under age 21 in the Home Relief program.
Currently 261,300 Medicaid recipients in upstate New York counties have voluntarily enrolled in managed care plans. These waivers will allow managed care enrollment of approximately 196,000 additional Medicaid clients in approved counties, resulting in savings of about $20 million over two years. Mandatory enrollment will begin this summer, and will be phased in over an 18–month period.
"In view of the continued delay in federal approval of New York's 1115 statewide mandatory Medicaid waiver proposal, the State will now file a similar 1915–b waiver request on behalf of New York City," Dr. DeBuono said.
Section 1915–b waivers are in effect for two years and allow states to implement mandatory managed care programs under pre–established federal rules for enrollment and service delivery. New York currently operates two 1915–b waiver programs – one in Southwest Brooklyn and one in Westchester County.
Section 1115 waivers, approved for five years, allow states to test new and innovative ways to administer their programs through managed care models. New York State filed its Section 1115 waiver request with the Health Care Financing Administration in March 1995, and is still awaiting federal approval. Under the 1115 waiver, New York would receive federal matching funds for the Home Relief population, which remains a state–county responsibility under the 1915–b waivers. The 1115 waiver would provide for mandatory managed care enrollment of most persons receiving Aid to Families with Dependent Children and Home Relief, plus a large percentage of those receiving SSI benefits. It also would allow creation of Special Needs Plans to provide care for the seriously mentally ill and people with HIV/AIDS.
Seventeen states –– including Rhode Island, Massachusetts, Vermont and Maryland–– have received federal approval for Section 1115 waivers. Over 30 states have implemented some type of Medicaid managed care program through 1915–b waivers.
"New York State is ready to implement a statewide mandatory Medicaid managed care program as soon as federal approval is received," Commissioner DeBuono said. "We currently have 38 qualified managed care plans participating in the Medicaid program, and a total statewide enrollment of 655,700."
The following counties are participating in the 1915–b waiver:
- Albany
- Broome
- Cattaraugus
- Chautauqua
- Columbia
- Cortland
- Delaware
- Erie
- Fulton
- Genesee
- Greene
- Herkimer
- Jefferson
- Monroe
- Montgomery
- Niagara
- Oneida
- Onondaga
- Ontario
- Orleans
- Oswego
- Putnam
- Rensselaer
- Rockland
- Saratoga
- Schenectady
- Schoharie
- Seneca
- St. Lawrence
- Tioga
- Yates
3/18/97–29 OPA
