The Moving Parts of Medicaid Reform CDPAANYS Annual Conference October 24, 2012 Presenter: Cathy Roberts, Senior Paralegal Empire Justice Center, Albany, NY

Mainstream managed care expansion – Mandatory managed care expanding to all counties by 2013 – Fewer people qualify for exemption i.e., even nursing home residents (non-duals) will be required to enroll 10/13 – More services in managed care package Personal care Prescription drugs Dental Consumer directed personal care

Integration of Care for Dual Eligibles : MLTC FIDA Health Homes

Managed long term care (MLTC) – Applies to:  dual eligibles (on Medicare and Medicaid)  age 21 and over AND  receiving 120 days or more of community based LTC services in a calendar year.  Over the next two years, they may be required to enroll in a MLTC plan, depending on where they live.

Roll-out schedule (anticipated)  NYC (actual timetable)  July 2012 – January 2013  Nassau, Suffolk, Westchester:  January 2013  Rockland, Orange:  June 2013  Albany, Erie, Onondaga, Monroe  December 2013  Other counties with capacity  June 2014

What about integration of non-LTC services?  NYS DOH seeking demonstration waiver, using two-pronged approach:  FIDA (Fully Integrated Dual Advantage)  Managed care model  All Medicare/Medicaid services provided through FIDA plan  Health homes  Managed fee for service system  Care management service model

Health home and FIDA enrollment process  Passive enrollment with “opt-out” provision  People will be automatically enrolled  They can decline the enrollment altogether, or choose a different FIDA or health home  Enrollment broker can assist with FIDA plan choice and enrollment

Timeline - FIDA  FIDA managed care  Who?  Full duals age 21+, need more than 120 days of LTC, not in mental health facility  Special FIDA plans for OPWDD beneficiaries  Where?  NYC, Nassau, Suffolk, Westchester (regular FIDA)  Statewide (OPWDD FIDA)  When?  Jan

Timeline - Health homes  Who?  Full duals age 21+, not in mental health facility, don’t need 120+ days of LTC services, AND meet ONE of the following criteria:  Two chronic conditions  Serious mental illness  Have HIV, are at risk of developing another chronic condition  Where?  Statewide  When?  Ongoing

Advocate Concerns  Complexity of Enrollment Choices  Continuity of care during transition  High need clients getting proper level of care  Loss of benefits  Davis v. Shah (Empire Justice, shoes & stockings)  Johnson v. Shah, Strouchler v. Shah (NYLAG, home care)  Reporting and state oversight

Promising Changes  New housing allowance for Medicaid recipients: New housing allowance for Medicaid recipients  Returning to the community after 30+ days at a skilled nursing facility  Enrolling (or enrolled) in a managed long term care program  Centralization/Automation  Renewals in Medicaid/ Medicare Savings Programs  Spend down activation  Health homes?  New enrollment system for State Health Insurance Exchange? (

Links to more info DOH webpage on Medicaid Redesign My contact information: Cathy Roberts, Senior Paralegal Empire Justice Center 119 Washington Avenue Albany, NY x 112