More Questions on Managed Care

AIDS activist Carroll left the DOH meeting seeking more answers

At a poorly publicized meeting Monday geared towards New Yorkers with HIV and AIDS, the State Department of Health took questions about the impending roll-out of mandatory managed care for Medicaid recipients living with HIV and the elimination of fee-for-service care at Designated AIDS Centers.

Despite the fact that this meeting was meant to be for all consumers, meeting notices were only released privately to the people living with HIV/AIDS on the Ryan White Planning Council, State Prevention Planning Group (PPG) and through the HIV CARE Networks. More meetings on mandatory HMO enrollment for consumers will be held on October 29 and 30. E-mail the AIDS Institute at omcmail@health.state.ny.us for more details.

A last minute get-out-the-date call by advocates brought some 100 consumers to the room, many of whom had a central concern: not having to give up their doctors when they are forced into HMOs. The panel, including Humberto Cruz and Ira Feldman of the AIDS Institute and Jay Laudato and Jennifer Dean of the Division of Managed Care, explained that most people will be able to maintain their primary care physicians, but that patients might not be able to retain their entire teams of doctors.

27,500 people with HIV and AIDS in the city are currently exempt from managed care because of their HIV status. 9,375 of them have already chosen managed care plans, and 3,300 in HIV Special Needs Plans (SNPs). SNPs were developed to provide quality managed care for New Yorkers with HIV and AIDS.

Disempowering Consumers

Some at the meeting questioned the need for the switch to mandatory HMO enrollment at all. The DOH has not announced plans for when the rollout will occur, but the State has applied for a waiver from the Federal Centers for Medicare & Medicaid Services in order to get the process underway.

"The meeting shouldn't be about how they are going to do the plan, but if they are going to do it," said Manuel Rivera, a member of the PPG, who attended the meeting. "If these plans are so great why don't they let everyone choose if they're going to do it? It's just another example of disempowering people with HIV and AIDS. Just because someone is infected, doesn't mean they lost their mind. They're able to make decisions."

Rivera said he was not satisfied by the DOH's response, which "talked around the issue." The DOH created a three system study of SNPs, mainstream managed care and fee-for-service care. The study found SNPs and mainstream managed care outperforming fee-for-service Medicaid on health outcomes.

However, the study doesn't look at quality analysis data outcomes, and mostly looks at if services were performed, not at the patient's health outcomes. For example, the study shows if a person is prescribed for ARVs, but not if he is adhering to meds.

The information provided about the new mandatory HMO plan was similar to that at the provider meeting in September with the differences between HIV Special Needs Plans and mainstream managed care explained, and the nuts and bolts of how people should transition. But many consumers left with unanswered questions.

"They keep telling us the care is going to be the same, but how are we supposed to know?" said Felicia Carroll, a consumer member of the Ryan White Planning Council. "I wanted more information, like what else is coming down the pipeline they're not telling us about. They should have made this all public earlier."