New York Health Department to decide soon whether Medicaid beneficiaries with HIV/AIDS should be moved into managed care plans

Aug 26 2008

The New York State Department of Health in the next few weeks is expected to issue a final decision on whether to switch Medicaid beneficiaries with HIV/AIDS from fee-for-service plans to managed care plans, the AP/Long Island Newsday reports (AP/Long Island Newsday, 8/24).

Since the late 1990s, the state's 65,000 people living with HIV/AIDS who are enrolled in New York's Medicaid program have been exempt from a statewide enrollment drive to place beneficiaries into managed care plans. About 10,000 HIV-positive beneficiaries were enrolled in Medicaid managed care plans as of late last year (Kaiser Daily HIV/AIDS Report, 12/3/07).

According to the AP/Newsday, some HIV/AIDS advocates have said that the change would result in lower quality care and that switching plans could interrupt services for some patients. Charles King, president and CEO of Housing Works, said, "This is being done simply to save the state money, and that's not a good argument for managed care."

Claudia Hutton, a spokesperson for the health department, said, "This is not about saving money. This is about using the money we spend to purchase better quality coverage for Medicaid patients." She added, "We used to have 6,500 doctors in Medicaid managed care ready to serve the needs of HIV/AIDS patients. Now we have 13,000. Most Medicaid fee-for-service providers serving AIDS patients are joining managed care networks to continue the doctor-patient relationship."

According to the AP/Newsday, the state health department said studies it has conducted indicate that all patients, including people living with HIV/AIDS, are more likely to thrive under managed care plans. In addition, officials said that Medicaid Special Needs Plans are available and can cater to patients' individual needs. Those enrolled in such plans reported fewer interruptions in relationships with care providers than those enrolled in fee-for-service plans and had fewer emergency department visits, fewer pneumonia cases and were more likely to obtain antiretrovirals.

A separate, preliminary study found that those with HIV/AIDS who are enrolled in regular Medicaid managed care plans in New York state are more than twice as likely as those in fee-for-service plans to be screened for breast cancer or cholesterol. However, those with HIV/AIDS enrolled in fee-for-service plans were more likely to have regular dental visits and have a continuous supply of antiretrovirals. Special Needs Plans "outperformed" both regular managed care plans and fee-for-service plans, according to the AP/Newsday (AP/Long Island Newsday, 8/25).