Newsletter Bulletin, Volume 13: What You Need to Know on Managed Care

ACA has released Newsletter Bulletin, Volume 12 for our affiliate network. 

Read CEO Jay Nagy’s message below:

What You Need to Know on Managed Care

Back in December, I shared some of the exciting opportunities shaping up for 2019, one of which was managed care. While it’s still early in the timeline, the people you support and their families may already have questions about this sensitive topic. You will continue to serve as a critical source of truth to them during these confusing times and we want to make sure you have the background you need to take on this responsibility.

The first thing to keep in mind is that only NYS Medicaid-funded services are impacted by this transition to managed care. If a person has Medicare or commercial insurance through family or work, those services remain unchanged and unimpacted. In those cases, only the HCBS waiver services a person receives (e.g. residential, habilitation, supported employment, self-direction, etc.) will transition into managed care. If someone gets "State Plan services” (e.g. medical/hospital, behavioral health, dental, pharmacy, etc.) through NYS Medicaid, then those services will also move into managed care under an integrated insurance plan. Depending on a person’s circumstances, different services are subject to the managed care transition. This has been and will continue to be a major source of confusion to families—and it’s something you can help clear up quickly when asked.

This spring, the “early adopters” will announce limited insurance plans covering Medicaid State Plan services (i.e. the non-waiver services/benefits a person may receive). Enrollment in these plans will be on a purely voluntary basis. The expectation is that these plans will eventually also cover waiver services, but there will initially be limited information available.

Following the “early adopters,” the state will approve “SIPs-PL” (Specialized I/DD Plans—Provider Led) sometime in late 2019 or early 2020. These plans will cover all the NYS Medicaid-funded services someone with I/DD might receive. If family members want to be in the same plan as their loved one, they are eligible for enrollment as well. ACA and its CCO partners upstate are applying to offer such a plan and we look forward to sharing more news on this over the coming months. Enrollment in these plans will initially be voluntary but, based on OPWDD’s current timeline, it will become mandatory by 2021.

People will be able to move around/change plans at all times and OPWDD expects to see a choice of plans before making enrollment mandatory. By 2020, everyone will have much more information on the various options and will be able to make an informed choice for themselves or their loved ones.

When choosing a managed care plan, it pays to consider all the options and ACA is working to deliver a solution that meets the needs of the people we support and their families. Stay tuned!

—Jay Nagy, CEO