Up to 50,000 New Yorkers will enroll in managed long-term care
NY Managed Care
November 30, 1997
Up to 50,000 Medicaid beneficiaries in New York will be able to enroll in managed long-term care plans under a new law recently signed by the governor.
As well as testing the potential of managed long-term care to save money for Medicaid, the new law also encourages residents to make their own plans for long-term care so that they will not have to depend on Medicaid.
A total of 24 long-term managed care programs could soon be operating, including PACE sites and other demonstration long-term care already approved in the state
The law stimulates the creation of more affordable continuing care retirement communities (CCRCs), makes available local tax-free financing for these facilities and senior housing and makes permanent a pilot project on private long-term care insurance called the Partnership for Long-Term Care. New York residents will also be able to access death benefits under a life insurance policy if they are chronically ill.
A total of 24 long-term managed care programs could soon be in operation, including PACE sites and other demonstration long-term care already approved in the state, said Keith McCarthy, senior health policy analyst for the Senate Health Committee. Plans will either have to "integrate capitated financing from Medicare with other funding sources, or have protocols to insure benefit coordination between Medicare and other financing sources," according to a memo on the new law. Reimbursement for Medicaid services, if not integrated with Medicare, will have to be capitated as soon as feasible.
Among the issues in the debate over managed long-term care were whether participation would be limited to provider-sponsored networks or also opened to HMOs. Chris McCormack, director of government relations for New York State Association of Homes and Services for the Aging, whose group advocated for using only provider-sponsored networks in long-term managed care, said a compromise was struck. About four or five HMOs will be able to participate in the managed long-term care program. Mr. McCormack’s group represents the not-for-profit nursing home industry which, he said, is eager to get into managed care.
Another issue was whether chronically ill Medicaid recipients would be allowed to enroll. Key legislators wanted to include the chronically ill in managed care to reap cost savings. Of the total number of Medicaid beneficiaries that has been authorized for enrollment into managed care, half will have chronic conditions.
The limits on enrollment make for a "bastardized version of managed care," acknowledges Mr. McCormack, but budget officials wanted to keep enrollment at this level until there was enough actuarial experience to show savings from managed care.
The law opens the door to "modified" CCRCs which, unlike the "life care communities" in the current law, offer less than the lifetime guarantee of nursing home care. In states surrounding New York, these modified continuing care facilities have proven to be more popular among consumers because they are "more affordable for people of moderate means," Mr. McCormack said. To obtain tax-free financing from local economic development grants, however, modified CCRCs must provide a minimum of one year of skilled nursing care, Mr. McCormack said.
The approval process and operating requirements for CCRCs will also be streamlined, according to Mr. McCarthy.
This change means those who want continuing care "don’t have to leave their setting or friends," said Marty Bayne, a broker for long-term-care insurance based in Clifton Park. Mr. Bayne also applauded the law for giving an official "imprimatur" to the Partnership program which was started with Robert Wood Johnson Foundation funding. The new name of the program is the Long-Term Care Security Demonstration Program.
Contact Mr. McCarthy at 518-455-2200; Mr. Bayne at 518-371-5522; or Mr. McCormack at 518-449-2707.
Up to 50,000 New Yorkers will enroll in managed long-term care
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