Medicaid Managed Care Program (1115 Waiver) Approved for New York City
Millions of Medicaid Recipients to Receive High Quality Preventive Health Care
ALBANY, May 26, 1999 - Acting State Health Commissioner Dennis P. Whalen today announced that New York State has received federal approval to begin mandatory enrollment of 1.5 million New York City Medicaid recipients in managed care plans to provide them with medical homes and access to primary and preventive care services.
"This is a great victory for the Governor and for New York City, this waiver will allow millions of medically needy New Yorkers the medical home and quality health care they need to live long healthy lives," Acting State Health Commissioner Dennis P. Whalen said.
Acting Commissioner Whalen said, "Thanks to Governor Pataki's leadership and persistence on this issue, the Medicaid managed care program in New York City is now a reality. More than one million Medicaid recipients in New York City will now have access to medical homes where they will receive the primary care and preventive health care they need to live longer, healthier lives."
The Health Department will review the conditions of approval, which are outlined in HCFA's approval letter and respond to HCFA with a start date. As specified in New York State's Special Terms and Conditions, the start date for mandatory Medicaid Managed Care enrollment in New York City must be agreeable to the State Health Department.
"Managed care will improve and maintain the health of Medicaid families by giving them for the first time access to such critical preventive health services as immunizations for children, lead screening, mammograms to detect breast cancer and tests for cervical and prostate cancer, all of which can be successfully treated if diagnosed in the early stage," the Acting Commissioner said. "Medicaid recipients will no longer have to rely on expensive hospital emergency rooms for routine medical care."
Currently 379,400 New York City Medicaid recipients have enrolled voluntarily in managed care plans. Mandatory enrollment of the additional 1.1 million eligible Medicaid recipients will be phased in over a two year period. Phase I enrollment will include 381,000 Medicaid recipients living in lower Manhattan, parts of Brooklyn and all of Staten Island.
Most new applicants for Medicaid who live in Phase I areas will be required to choose a managed care plan and a primary care physician to coordinate their medical care. Existing Medicaid recipients living in Phase I zip codes will need to enroll in a managed care plan at the time of their Medicaid recertification.
The State Health Department has contracted with Maximus, Inc., a national information technology company, to educate Medicaid recipients about how managed care works and to help them choose a plan that best meets their medical needs. Maximus provides a toll-free number as well as outreach workers in city and community-based locations to assist in the enrollment process.
Persons eligible for managed care enrollment will receive an information packet including a brochure that spells out their rights and obligations under managed care, information about exemptions/exclusions, a list of available managed care plans, and a pre-printed enrollment form with a return envelope.
New York City has 18 managed care plans approved to enroll Medicaid recipients; these plans have a total of 6,576 participating primary care physicians and 20,152 physician specialists.
Medicaid recipients will have 60 days to choose a plan. Any Medicaid recipient who does not choose a plan within 60 days will be assigned to a plan. Clients have 90 days from their enrollment start date to change plans without cause. After that time frame, most clients will be required to remain in the same plan for the next nine months.
New York State 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.
Medicaid beneficiaries in institutions or foster care are excluded from managed care. Persons with HIV/AIDS, serious mental illness, developmental disabilities or language barriers may enroll in managed care if they so choose, but they may apply for an exemption from the mandatory rules.
Statewide, there are nearly 650,000 Medicaid beneficiaries enrolled in managed care. Twelve upstate counties have received approval to commence mandatory Medicaid managed care enrollment.