State Begins Medicaid Managed Care Program (1115 Waiver) in New York City
Millions of Medicaid Recipients to Receive High Quality Preventive Health Care
Albany, August 9, 1999 – State Health Commissioner Antonia C. Novello M.D., M.P.H. today announced that New York State has initiated mandatory enrollment of 1.5 million New York City Medicaid recipients in managed care plans to provide them with medical homes and access to high quality primary and preventive care services.
"Once again, New York leads the nation in protecting the health of our most vulnerable citizens," Dr. Novello said. "When something important needs to be accomplished, New York makes it happen. Governor Pataki's leadership and tireless efforts to secure the waiver are another example of this commitment to the health of all New Yorkers and I am proud to be his partner in this landmark program."
"Today we are welcoming millions of medically needy New Yorkers, including our precious children, into medical homes where they will receive the health care they need to live longer and healthier lives," Dr. Novello said. "Imagine what it will mean for so many Medicaid families, for the first time, to have regular access to immunizations, lead screening, mammograms and tests for cervical and prostate cancer. No more waiting until serious illness strikes, or relying on expensive emergency rooms for routine medical treatment. Today is the beginning of a bright promise of better care."
Currently 378,102 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 382,000 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 now 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 soon after their Medicaid re–certification.
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 telephone number (1–800–505–5678) 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 preprinted 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. Those clients who do not change health plans in the first 90 days, will be permitted to do so, if they wish, 12 months after enrollment.
New York State closely monitors the quality of care provided by managed care plans to the State's Medicaid population, including close surveillance of enrollment, complaints and the delivery of care. In addition, managed care plans are required to report data to the Health Department annually. The State uses this data to assess each plan's performance on a wide range of preventive health measures. The Health Department annually 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, or they may apply for an exemption from the mandatory rules.
Statewide, there are nearly 650,000 Medicaid beneficiaries enrolled in managed care. In addition to New York City, 12 upstate counties are currently enrolling Medicaid recipients in managed care under New York's mandatory program.