Monroe and Ontario Added to Medicaid Managed Care Program
Albany, March 13, 1998 – State Health Commissioner Barbara A. DeBuono, M.D. today announced that Monroe and Ontario counties have been approved to begin mandatory enrollment of Medicaid clients in managed care plans, ensuring that more than 20,000 additional Medicaid recipients will receive high quality primary and preventive health care.
"Managed care gives children and families a medical home and access to preventive medical services and early diagnosis of health problems," Dr. DeBuono said. "Children will receive routine check–ups, immunizations and lead screening. Women will receive early prenatal care and regular screening for cervical cancer and breast cancer, including mammograms."
So far, nine counties have commenced mandatory Medicaid Managed Care programs.
In addition to Monroe and Ontario, these are Albany, Columbia, Greene, Rensselaer, Niagara, Saratoga and Westchester. Southwest Brooklyn also has a mandatory Medicaid managed care program.
Monroe County Executive Jack Doyle said, "Monroe County is now able to move forward with its goal of providing the preventive health benefits of managed care to most Medicaid recipients. I am especially pleased that community health centers in Rochester will be participating in this effort, as they are an integral part of our Medicaid health care delivery system."
"Medicaid managed care and the state's nationally–recognized Child Health Plus program provide our most vulnerable populations with the health care they need and deserve," said Dr. DeBuono. "We are maintaining an aggressive timetable to ensure Medicaid recipients across the state receive the same primary and preventive services that are now being offered in Monroe and Ontario Counties."
New York closely monitors the quality of care provided by managed care plans to the State's Medicaid population. Managed care plans are required to report data to the Health Department annually to allow the State to assess their performance on a wide range of preventive health measures. The Health Department publishes these reports for consumers. New York also has created the most comprehensive set of consumer protections for managed care patients under the State's Managed Care Bill of Rights legislation and the Medicaid Managed Care Act.
Both Monroe and Ontario counties have begun the process of notifying eligible Medicaid clients of the need to select a managed care plan within 60 days. Information about how managed care works and client choices for enrollment must also be provided to Medicaid recipients before they enroll.
Those required to enroll in Medicaid managed care are women and children receiving public assistance under the new Temporary Assistance to Needy Families program (previously Aid to Families of Dependent Children) and persons in the Safety Net Program (formerly Home Relief ). Persons with HIV/AIDS and those with serious mental illness will not be required to enroll in managed care until Special Needs Plans are available to meet the complex health needs of these groups.
Monroe County currently has an estimated 48,000 Medicaid clients eligible for managed care, of whom 27,000 have already enrolled in managed care plans on a voluntary basis.
Ontario County has an estimated 4,200 eligible Medicaid clients, of whom 1,220 are already voluntarily enrolled in managed care.
Both counties are served by the same two managed care organizations: Blue Choice HMO Option and Preferred Care. Additionally, three independent community health centers in the Greater Rochester area, the Anthony Jordan Health Center, Oak Orchard Community Health Center and Westside Health Services will be participating in Medicaid managed care, continuing the provision of primary and preventive care to thousands of Medicaid clients.
Before a county is allowed to begin mandatory enrollment of Medicaid recipients, the State Health Department and the federal Health Care Financing Administration must evaluate the adequacy of available managed care plans and health care providers to meet the needs of Medicaid recipients.
Mandatory enrollment in the rest of the state will continue on a phased–in basis over a five year period. New York's statewide program will include 2.2 million Medicaid recipients, of whom 650,000 are now in managed care.