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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

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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 Health

Long-Term Care

Services for DD1 Eligible Enrollment2

Existing Plans

Mainstream Medicaid Managed Care Non-dual children, adults, elderly & physically disabled 2,267,703

Man

aged

Lon

g-

Term

Car

e

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

HIV Special Needs Plan Non-dual children, adults, elderly & physically disabled, with HIV 16,405

New plans Anticipated Enrollment

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

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

FIDA

Fully Integrated Duals Advantage

• Focus on dual eligible beneficiaries

• 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

HARPs

Health and Recovery Plans

• Focus on complex adults beneficiaries in need of behavioral health services

• 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

DISCOs

Developmental Disabilities Individual Support & Care Coordination Organizations

• 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

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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

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

765

5,558

0

2,000

4,000

6,000

8,000

6.3x

April 2015 March 2015

Passive enrollment of all dual-eligibles in NYC & Nassau County began on 4/1

75%

100%

50%

0%

25%

Other (17)

April 2015

25

13

11 8

43

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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

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