The Update continues its analysis of the New York State Medicaid reform proposals and how they affect low-income New Yorkers, especially those living with HIV.
While we've criticized the reform process and scrutinized a few potentially harmful proposals, we recognize that there are many beneficial ideas in the Medicaid reform package. Among the 79 proposals, for example, are suggestions to expand smoking cessation programs, increase HIV testing and require nursing homes to provide patient-centered palliative care.
Today, we lay out the details of three proposals that would help many of the state's 4.7 million Medicaid users.
Proposal 1021: Facilitates the Co-Location of Physical Health, Behavioral Health and Disability Services
What it means: Care providers could use one space to offer multiple kinds of services to people who need help, reversing a policy that has generally compelled providers to build separate facilities for distinct services.
Who it affects: People who access behavioral health or developmental disability services; licensed operators of those services (including Housing Works).
How it helps Medicaid recipients: Health care providers must seek licenses from various agencies -- such as the Department of Health or the Office of Alcoholism and Substance Abuse Services -- when they want to provide services. Licensing policies make it nearly impossible for providers to house different licensed services -- like health care and drug treatment -- in one convenient place.
The change would save community organizations money and make it easier for individuals to access treatment for multiple conditions in one place.
Organizations like Harlem United, which provides health, housing and HIV prevention services to about 12,000 individuals a year, could reach a greater number of people. "It's our hope that proposal 1021 will eliminate barriers and duplicative administrative requirements so that we can deepen our services in communities most in need," said CEO Steven Bussey.
Proposal 89: Implements "Health Home" for High-Cost, High-Need Medicaid Recipients
What it means: People receiving "health home" services are assigned to a single organization that coordinates all care, including medical and behavioral health services, post-hospital follow-up, family support and referral to social services. Proposal 89 would require that certain high-cost, high-need patients enroll in this type of care.
Who it affects: High-cost, high-need patients, including many homeless people with co-occurring chronic conditions such as mental illness and chemical dependency; hospitals; clinics; physicians; managed care organizations, behavioral health care service providers; nursing homes; long-term care provers; industry associations; community support organizations such food pantries and job training centers.
How it helps Medicaid recipients: "It means everybody who's in touch with the patient is in touch with each other," said Charles King, Housing Works president and CEO. "You're gaining efficiency and you're giving better care." The proposal would reduce hospital and emergency room costs by ensuring that the most expensive Medicaid users access preventive care; and it would improve health outcomes for the people who are often the hardest to serve.
Proposal 101: Develops Initiatives to Integrate and Manage Care for People Enrolled in both Medicare and Medicaid
What it means: The state would try to get more "dual eligibles" into managed care.
Who it affects: People who receive both Medicaid and Medicare; health care providers.
How it helps Medicaid recipients: Managed care programs typically cost states less and, if properly run, can improve health outcomes for consumers. But in New York, mandated managed care applies just to people who only use Medicaid. Once a person has Medicare, he or she is typically ineligible. At the moment, only a few managed care plans serve "dual eligibles," and the savings from such programs usually go to the federal government.
Under proposal 101, the state would create demonstration projects that would manage the care of dual enrollees, and savings could be shared by the state and federal governments.
The state's Medicaid Redesign Team submitted 79 proposals for overhauling the massive health care program for the poor, and Housing Works has released a document analyzing the 35 that will have the greatest impact on people living with HIV. Of those 35, we support 20 -- and oppose three (our take on the others depends on their implementation). The proposals will not become policy until the legislature incorporates them into the 2012 budget -- leaving health care advocates several weeks to influence the process.
"There's some things in this reform package that are just unabashedly great for people," said King. "And it's important that we advocate for their inclusion in the final proposal, because in doing so, we end up shaping the program."