By Melvyn R. Tanzman, Executive Director
There has been considerable fear and confusion regarding the changes mandated by Governor Cuomo’s Medicaid Redesign Team, most significantly community local term care or home care becoming the responsibility of contracted Managed Care Organizations. Many questions are out there: Will my home care services be reduced? Can I keep my current aide and agency? What if I’m currently in a waiver program? It is difficult to answer many of these questions, as the new initiative is a work in progress, and even the timetable for implementing it is still changing. But here is the most current information: The Federal Center for Medicare and Medicaid Services only approved NYS’s plan on August 31,2012, and the transition to Managed Long Term Care began in New York City on 9/17/12, two and a half months after it was planned. Under the current schedule Westchester and the rest of Downstate NY is not scheduled to begin the transition until January 2013, however it will likely be delayed due to the delayed roll out in New York City. It is important to note that individuals participating in the two waiver programs, Nursing Home Transition and Diversion and Traumatic Brain injury are not due to transition until September 2015, and the Long Term Home Health Care (Lombardi) Program originally scheduled to transition in January 2013, has been put on hold indefinitely. Consumers participating in these waivers have been given a valuable resource- time.
So I know I’ve confused you, but let me give one practical recommendation: DO NOT ENROLL IN MEDICAID MANAGED LONG TERM CARE UNTIL IT IS MANDATORY. Consumers have the option to voluntarily enroll now and some Managed Care Organizations (MCOs)have begun an aggressive marketing campaign to encourage voluntary enrollment. FRANKLY THERE IS NO BENEFIT TO ENROLLING IN MANAGED LTC NOW. I have heard that at least one MCO has promised potential members that they would not be held responsible for their spend- down if they enrolled now. Such a practice is illegal and fraudulent. DON’T BUY IT! REMEMBER THAT THESE MARKETERS ARE SALESPEOPLE. If you are approached to enroll in managed long term care and you are made promises or you are told that it is mandatory, please alert a staff member at WDOMI about the incident. In closing, during this transition time delay is very valuable. It gives us a chance to track how well different MCOs serve us, and for advocates to properly advise our constituents.