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TBI/NHTD Carve-out of Medicaid Managed Care

Support A.2442 (Gottfried)/S.1870 (Hannon)

Apart from issues included in the 2017-18 State Budget legislation, the Department of Health (DOH) agreed in a side letter to address several other concerns that were raised during the budget negotiation process and included in the legislative one-house budget proposals. One such concern was the transition of the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waivers into Medicaid managed care. In the side letter, DOH agreed to delay the waiver transition for an additional year, until Jan. 1, 2019. While this delay is an important step, we believe there should be a permanent carve-out.

At this time, managed care plans already have all they can handle transitioning the current populations and would struggle to deal with a whole new risk pool with its own new set of complications. New York moved the nursing home benefit into Managed Long Term Care in July 2015; adding yet another high acuity population such as TBI/NHTD to plans would undoubtedly place some plans in further peril and consumers in jeopardy.

There are also no cost savings associated with moving TBI/NHTD into managed care. Given the significant programmatic changes absorbed by Medicaid managed care and Managed Long Term Care plans in recent years, the interests of all stakeholders would be best served by focusing on current populations and benefits.

Enter your information to send a letter to your lawmakers, urging them to support A.2442 (Gottfried)/S.1870 (Hannon). You can also access LeadingAge NY's memo of support here.