A.7598 (Gottfried)/S.5535 (Hannon)

In early 2016, the New York State Department of Health (DOH) plans to move nearly 5,000 people getting critical services through the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) Medicaid waivers to Medicaid managed care.  But consumers, providers and other important stakeholders have not been involved in planning the transition of these populations and the array of services unique to the waivers into a managed care model.  This legislation is crucial to a successful transition, allowing these special populations to continue to live a full life in their communities.

The TBI and NHTD waivers provide specialized services that help people with traumatic brain injuries, dementia, and other disabilities avoid nursing home or other institutional placement.  While the populations served by the waiver programs are small, their needs are complex, and many of the services they receive are not traditionally available in Medicaid or commercial insurance.  Rushing to move the waiver populations to managed care risks service disruption and much more – it puts people who rely on the waiver programs at risk of institutionalization.  Because managed care plans have little or no experience working with these populations or providing the types of services they need to remain in the community, it is critical that the transition to managed care be done in a paced, deliberate and well-thought out manner.

S.5535/A.7598 would slow down the transition to managed care and require DOH to take time to convene a stakeholder work group (including payers, consumer representatives, providers of services, and the chairs of the Assembly and Senate Health Committees) to ensure a thorough and thoughtful discussion on how to best transition these populations to managed care.  The legislation would require the work group to consider several critical principles in developing a transition plan and make recommendations to the Commissioner of DOH.

For these reasons, Empire Justice Center supports this legislation.