Defining the Path Forward: The NY Launch of Medicaid Special Needs Plans MAY 2015
Martin Graf, Partner Jim Fields, Partner Parie Garg, Principal www.oliverwyman.com
Š Oliver Wyman
As part of new regulations, New York has added Special Needs Plans (SNPs), which will increase its Medicaid offerings to eight plans Physical Health
Behavioral Long-Term Health Care
Services for DD1
Eligible
Enrollment2
Existing Plans
Managed LongTerm Care
Mainstream Medicaid Managed Care
Non-dual children, adults, elderly & physically disabled
2,267,703
Partial Capitation
Elderly & physically disabled, including duals
114,383
Program for All-Inclusive Care for the Elderly (PACE)
Elderly & physically disabled, including duals
10,888
Medicaid Advantage Plus (MAP)
Dually eligible elderly & physically disabled
4,930
Non-dual children, adults, elderly & physically disabled, with HIV
16,405
HIV Special Needs Plan
Anticipated Enrollment
New plans Fully Integrated Duals Advantage (FIDA)
Dually eligible elderly & physically disabled
~140,000
Health and Recovery Plans (HARPS)
Non-dual adults w/ mental illness and/or substance use disorders
~140,000
Developmental Disabilities Individual Support & Care Coord. Orgs. (DISCOS)
Individuals with developmental disabilities
Unknown
Source: NY DOH, Medicaid Institute 1. Developmentally Disabled; 2. Enrollment numbers are from Department of Health’s Enrollment Reports, January 2014 Š Oliver Wyman
No services provided Limited services provided Full scope of services provided
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The SNPs provide care for individuals with complex healthcare needs SNP Plan
Description Fully Integrated Duals Advantage • Focus on dual eligible beneficiaries
FIDA
• Three-year demonstration program began in 2015 • Integrates all Medicare / Medicaid benefits into a single managed care benefit package • Enrollment is voluntary, but beneficiaries who opt out are subject to mandatory MLTC enrollment • Up to 140,000 duals residing in eight downstate counties could be enrolled Health and Recovery Plans • Focus on complex adults beneficiaries in need of behavioral health services
HARPs
• Slated to begin in 2015 • HARPs must contract with health homes • Beneficiaries who do not meet eligibility threshold must join a mainstream managed care plan Developmental Disabilities Individual Support & Care Coordination Organizations
DISCOs
• For beneficiaries with developmental disabilities • Will serve as both the care coordination organization and the fiscal intermediary • The DISCO benefit package will not include most primary and acute medical care services
Plans are designed to combat fragmentation in care delivery for complex patients Source: Medicaid Institute © Oliver Wyman
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However, enrollment in FIDA has been limited and fallen short of targets, despite passive enrollment commencing on April 1, 2015 FIDA Enrollment in New York State1 Number enrolled, March and April 2015
FIDA Market Share by Plan Plan share (% of total enrollment), April 2015
8,000
100% 6.3x
6,000
5,558
75%
4,000
50%
2,000
25%
43
Other (17)
8 11 13
765
25
0
0% March 2015
April 2015
April 2015
Passive enrollment of all dual-eligibles in NYC & Nassau County began on 4/1 Source: CMS monthly enrollment report for April 2015, Capital New York “Slow start for ambitious state Medicaid initiative” 3/5/15 1. FIDA enrollment only available currently in NYC counties (Kings, New York, Queens, Richmond) and in Nassau County; Independent Care System © Oliver Wyman
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Three keys to moving forward
Know your members Have a field force at the ready Address opt-out issues head on
For more on this topic, visit: Managed Medicaid: The Dual Eligibles Opportunity © Oliver Wyman
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Š Oliver Wyman
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