Provides that services to medical assistance recipients suffering from traumatic brain injuries or qualifying for nursing home diversion and transition services shall be provided outside of managed programs

Section 2 of the bill provides for an immediate effective date.

Justification

Individuals who suffer from traumatic brain injury (TBI) and are served by a Medicaid waiver or who have some other disabilities that qualify them for the Nursing Home Transition and Diversion Waiver (NHTD) have varied physical and cognitive disabilities that make them particularly vulnerable to institutionalization. The Federal Medicaid Waivers were established many years ago because the state recognized these vulnerabilities and needs for special services and supports to help individuals live in the least integrated setting. These programs have served as a national model.

Given the unique needs of this small population of Medicaid recipients, the legislature introduced legislation in 2015 to delay the move of the TBI/NHTD waivered population into managed care and require that a work group of stakeholders be convened to make recommendations on transition of these services into managed care. The Department of Health ultimately committed to delay the transition until January 2017 and created a workgroup which met many times. In late January 2016 the Department shared its draft transition plan with the workgroup and concerns were raised that the draft transition plan does not reflect the workgroup's recommendations nor conversations with the Department. A series of further weekly meetings were schedule as a result. Of particular concern has been the assessment tool, how existing services fit into managed care and the process by which plans would qualify individuals and determine approved services, particularly for individuals who may find themselves with a traumatic brain injury or other disability after the move to Medicaid managed care.

Even Managed Long Term Care Plans have expressed concerns about taking on this population. New York is still in the midst of moving other populations into managed care and those transitions are far from complete or without concerns. Most recently, the behavioral health component was carved into managed care, yet the model contracts upon which plans and providers operate, have yet to be approved by CMS. Similarly, there are few details about the State's plan to implement the Community First Choice Option, which also awaits CMS approval, upon which TBI/NHTD waiver transition seems to hinge. Managed Long Term Care Plans, who would enroll TBI/NHTD individuals, are self reporting that they are already in a fragile state with many of those plans experiencing operating losses. In July 2015, New York moved the nursing home benefit into MLTC and the affect of that high acuity population being added to MLTC plans is putting additional pressures on the system Adding yet another high acuity population such as TBI/NHTD to plans which haven't even had a year to absorb the last transition will undoubtedly place some plans in further peril and ultimately consumers in jeopardy.

There are no cost savings associated with moving TBI/NHTD into managed care and given the vast changes the Medicaid program is currently undergoing, the State would be best served by placing all its attention on the populations it has already begun moving into managed care. Moving the vulnerable populations served under the TBI/NHTD waiver into managed care at this time would be a tremendous disservice to all involved.

Legislative history

New Bill

Fiscal implications

None

Effective date

Immediately