Defining the Path Forward

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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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