Recently the New York State Department of Health (DOH) announced the names of some of the members of the workgroups for Governor Andrew Cuomo’s Medicaid Redesign Team (MRT) effort.  Three of the nine workgroups that are charged with the work to implement key provisions of the MRT proposal are:

• Managed Long Term Care (MLTC) Implementation and Waiver Redesign;
• Behavioral Health Reform; and
• Program Streamlining and State/Local Responsibilities. 

The MRT was charged with identifying the best ways to reduce costs and improve the health delivery system in the state. Most of the team’s 79 recommendations were incorporated into the 2011-2012 New York State Budget, which passed on March 31.  The budget included sweeping legislation that will dramatically alter the way the state pays for and delivers Medicaid services, particularly in home- and community-based settings. 

Profound Impact of MLTC Reforms

Included in the New York State budget is a proposal to expand the use of capitated care management models, which – combined with reimbursement cuts – has the potential to change the landscape of home care.  

Beginning in New York City in April 2012, all people with Medicaid and the “dually eligible” — people with Medicare and Medicaid coverage — over the age of 21 who need community-based long-term care services for more than 120 days will be required to enroll in a MLTC plan or another care coordination program. New York State will first need the federal government’s permission to implement its plan.

DOH anticipates transitioning approximately 2,000 clients a month into a MLTC plan over a period of three years. MLTC plan is a term that applies to New York’s Medicaid Managed Long Term Care plans, Medicaid Advantage Plus, or the Program of All-inclusive Services for the Elderly (PACE).

PHI Role within Reform

Carol Rodat, PHI New York policy director, and Marilyn Saviola, director of advocacy at Independence Care System (ICS) – the PHI-affiliated managed long-term care organization – were both named to the MRT Managed LTC workgroup. 

The MRT Managed LTC workgroup is charged with, among other things, the task of advising DOH on:

• the development of care coordination models to be used in the mandatory enrollment;
• processes to ensure patient protections and access;
• continuity of services; and
• avoidance of nursing home placement and hospital stays.

PHI and ICS have been active proponents for wage improvements for home health aides as well as the greater use of care management models. Both of these provisions were in the blueprint (pdf) they presented to the MRT.

The New York State MRT website contains a list of all participants and meeting dates for the three MRT workgroups, as well as additional MRT information.