NYAPRS Note: Medicaid Director Jason Helgerson’s address at the UHF annual Medicaid forum, noted below, recapped the successes and challenges of Medicaid Redesign since its inception. Noting victories like maintaining the global cap and implementing health homes, he also recognized that transitioning those measures effectively as the rest of the system prepares for distinct managed care movements on various timelines that don’t coincide. Once again, he used the term ‘care management for all’ as a synonym to managed care; the former has not been defined across populations and the latter has not been held to a universal standard for assessment and plan of care development. Audience participation after his keynote was minimal, though concerns were raised about the exclusion of BH community providers on safety net provider lists for DSRIP. Mr. Helgerson reasserted his commitment to the inclusion of community providers in “serious transformation efforts” but did not indicate a plan for their inclusion or willingness to forward an agenda for community BH participation.
An Update on New York’s Medicaid Reforms
Crain’s New York Business, 7/17/2014
With so much riding on the success of New York’s Medicaid reforms, Jason Helgerson used his keynote address at yesterday’s annual Medicaid conference sponsored by the United Hospital Fund to ask providers to “work seriously and engage in dialogue with your community and work together to put together the strongest plans. We’re all in this together. If we don’t perform as a state, we’re all going to see less money.”
The state’s Medicaid director provided an update of the Medicaid Redesign Team’s plan: 235 initiatives implemented, with sweeping changes to come. Medicaid spending per enrollee fell to $8,500, a level comparable to that in 2003. Through April, Medicaid expenditures in the last fiscal year were $7 million below projections. At the same time, the state’s quality measures have improved.
“We don’t have national comparative statistics out yet, but I would be very interested to see whether or not we still rank as the highest state in the country on a per recipient basis,” said Mr. Helgerson. “Even though we’ve controlled cost, we haven’t seen reductions in quality. We’ve seen slight increases.”
The new FIDA program begins passive enrollment in April and July of 2015 in the downstate region. Mr. Helgerson called FIDA “one of the more complex implementations we have. We will also hopefully move forward in the not-too-distant future with a special FIDA model for the developmentally disabled.”
Adult behavioral health patients will transition to managed care in New York City in January. Mr. Helgerson sees the new HARP program as an opportunity for the state to expand care, break down silos between physical and mental health providers, and become a national leader in offering broad services to behavioral health patients.
Challenges ahead include the implementation of DSRIP and the federal Medicaid waiver. “The scale of a statewide implementation of this type has never been tried,” added Mr. Helgerson. “At the end of the day, the future of each community is going to be dictated by the providers and stakeholders in that community coming together and putting together the best plan.”