» Two United Hospital Fund Reports Document Large Three-Year Shift to Managed Long-Term Care for Elderly and Disabled Medicaid Beneficiaries in New York

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Two United Hospital Fund Reports Document Large Three-Year Shift to Managed Long-Term Care for Elderly and Disabled Medicaid Beneficiaries in New York

Implementation of State’s Mandatory Enrollment Policy Aims at Improving Quality and Containing Costs



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Two new reports from the Medicaid Institute at United Hospital Fund analyze the implementation of mandatory managed care enrollment for New York’s Medicaid beneficiaries receiving long-term care services (i.e., the frail elderly and physically disabled relying on community-based long-term care services and supports).

 

The issue brief, Mandatory Managed Long-Term Care in New York’s Medicaid Program: Key Eligibility and Enrollment Issues, examines the growth in managed long-term care enrollment between December 2010, before the mandatory policy was proposed, and October 2013. Over this period, managed long-term care enrollment nearly quadrupled, from about 33,000 enrollees to 123,000. The report examines enrollment growth by region and product line, as well as the accompanying changes to the structure of the managed long-term care market.

The State’s decision to mandate managed care for these beneficiaries is part of its overarching principle of care management for all Medicaid beneficiaries across the spectrum of physical health, behavioral health, and long-term care services and supports. The report notes that the rollout of this expansion, and related operational issues, will have implications for future managed care expansions, including for those dually enrolled in Medicaid and Medicare (slated to begin in October) and for other specialized populations in New York’s Medicaid program.

The report also examines the three different types of plan into which beneficiaries could enroll: Partial Capitation, Program of All-Inclusive Care for the Elderly (PACE), and Medicaid Advantage Plus. Partial Capitation enrollees accounted for 92 percent of all managed long-term care enrollees by October 2013.

The data brief, Home- and Community-Based Long-Term Care in New York’s Medicaid Program: New Data on Service Use and Spending, provides additional statistical documentation of the transition to managed care for Medicaid long-term care beneficiaries, including a corresponding statewide decline of 70 percent in the number of fee-for-service personal care users (from 57,807 Medicaid beneficiaries in December 2010 to 17,220 in October 2013). It presents analysis of regional differences in services and spending—reflecting long-term regional variation in utilization of community-based services, as well as staged managed care rollout throughout the State—and evaluates the growth in Medicaid managed long-term care and the corresponding decline in personal care and other home- and community-based service use.

“If you had asked me a few years back whether it would be possible to move most of New York’s beneficiaries receiving long-term care services from a fee-for-service model into managed care by 2013, I’d have been highly skeptical,” said Sarah Samis, senior health policy analyst and author of both reports. “But that is what New York has accomplished.”

Mandatory Managed Long-Term Care in New York’s Medicaid Program: Key Eligibility and Enrollment Issues and Home- and Community-Based Long-Term Care in New York’s Medicaid Program: New Data on Service Use and Spending are both available from the Fund’s website.

“Now that Medicaid has enrolled these patients in managed care, our continuing opportunity focuses on the longer-term vision: improving the quality and effectiveness of care for these beneficiaries while containing costs,” said Jim Tallon, president of the United Hospital Fund. “The affected beneficiaries are some of Medicaid’s most complex, and therefore costly, so the opportunity is real.”

About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose primary mission is to shape positive change in health care for the people of New York.

About the Medicaid Institute: The Medicaid Institute at United Hospital Fund provides information and analysis explaining New York’s Medicaid program, with the goal of helping all stakeholders redesign, restructure, and rebuild the program.

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