6“All LTI Graduates thatserve on the Board of Directorsand/or a Community Advisory Boardfor a not-for-profit organization areencouraged to register for thetra<strong>in</strong><strong>in</strong>gs listed below.”
nationalFEDERAL MEDICAIDCUTS LOOMINGRepr<strong>in</strong>ted from New York AIDS Coalition(NYAC), News From DC, July 30, 2008Readers of “News from DC” mayrecall NYAC highlight<strong>in</strong>g seriousprob<strong>le</strong>ms with the BushAdm<strong>in</strong>istration’s proposed Medicaid regulations.The impact of the Medicaidregulations on New York State alone wasprojected to exceed $1.5 billion <strong>in</strong> thefirst year. As a result of activism fromthe HIV/AIDS, disability, and Medicaidcommunity, Congress passed a one-yearmoratorium on six of the seven proposedregulations. However, Congress did notstop one regulation, which impacts onMedicaid reimbursement for hospitaloutpatient and community based services.The fiscal impact of this oneregulation on state Medicaid programs,<strong>in</strong>clud<strong>in</strong>g New York’s, will be significant.The Governor’s office predictsthis regulation will costNew York State at <strong>le</strong>ast$350 million dollars.The rema<strong>in</strong><strong>in</strong>g regulation is extremelycomp<strong>le</strong>x, but <strong>in</strong> summary would appearto limit Medicaid reimbursement forhospital outpatient and communitybasedservices to only those servicescovered by Medicare, and ensure thatreimbursement is similar to theMedicare rate. This would essentiallyprohibit federal Medicaid match<strong>in</strong>g dollarsfor services that Medicare does notcover, such as methadone ma<strong>in</strong>tenanceservices, renal dialysis, family plann<strong>in</strong>gservices, and some mental retardationand developmental disability services,to name a few. Consider<strong>in</strong>g thatMedicaid and Medicare generally serveentirely different groups of <strong>in</strong>dividualswith very different needs, NYAC isextremely puzz<strong>le</strong>d beh<strong>in</strong>d the logic ofmatch<strong>in</strong>g up Medicaid with Medicarereimbursement. It makes no sense.Governor Paterson’s Wash<strong>in</strong>gton DCoffice recently generated a memo thatdescribes the impact of this oneMedicaid regulation on New York. TheGovernor’s office predicts this regulationwill cost New York State at <strong>le</strong>ast $350million dollars. These regulations would(cont<strong>in</strong>ued on page 8)Medicaid Managed Care for Peop<strong>le</strong> With HIVMay Be Mandatory SoonRepr<strong>in</strong>ted from New York AIDS Coalition (NYAC), News From Albany July 30, 2008HIV/AIDSad<strong>vo</strong>cates have begun to <strong>le</strong>arn that the [NY]State Department of Health may soon announceplans to beg<strong>in</strong> requir<strong>in</strong>g persons liv<strong>in</strong>g with HIV/AIDS on Medicaid to enroll<strong>in</strong> managed care plans. Up until now, persons liv<strong>in</strong>g with HIV have beenexempt from requirements to enroll <strong>in</strong> either an HIV Special Needs Plan (HIVSNP) or standard managed care. This process may beg<strong>in</strong> as early as January2009, only six months away. From what NYAC has <strong>le</strong>arned, mandatoryenrollment of PLWHAs on Medicaid <strong>in</strong>to managed care plans will beg<strong>in</strong> <strong>in</strong>New York City first. Whether it will expand beyond NYC is not known yet.However, this news is alarm<strong>in</strong>g for a number of reasons, and NYAC has severalquestions/concerns (and this list is not exhaustive):• It elim<strong>in</strong>ates PLWHAs choices <strong>in</strong> Medicaid and narrows their health careoptions.• To date, the State Health Department has provided no <strong>in</strong>formation on howmany HIV specialists are <strong>in</strong> each of the Medicaid managed care planslicensed across the State. There are approximately 67,000 persons liv<strong>in</strong>gwith HIV who rely on Medicaid for their health care <strong>in</strong> NYS; do each of thestandard managed care plans have enough (if any) HIV specialists to treatall of these <strong>in</strong>dividuals?• In areas with high concentrations of persons liv<strong>in</strong>g with HIV, are thereenough providers and HIV providers <strong>in</strong> each of the plans to care for all thehuge <strong>in</strong>flux of PLWHAs?• As persons are auto-enrol<strong>le</strong>d <strong>in</strong>to managed care plans, what will happen tobeneficiaries who suddenly <strong>le</strong>arn they can no longer see the doctor(s) thatthey have been rely<strong>in</strong>g on for years for care? Will each of the plans beprepared to guide each and every beneficiary to appropriate providersexperienced <strong>in</strong> HIV?• What ro<strong>le</strong> will the HIV SNPs play <strong>in</strong> this mandatory enrollment process? Willpersons only be auto-assigned to standard managed care plans, or will theHIV SNPs also be <strong>in</strong>cluded <strong>in</strong> any auto-enrollment process?• What steps will the State Health Department take to monitor the plan’sperformance for PLWHAs?• Will NYS DOH provide resources to HIV service organizations so that a widelypublicized public awareness campaign and outreach effort will be conductedto ensure that all PLWHAs are aware of their options before the autoenrollmentprocess beg<strong>in</strong>s?NYAC is coord<strong>in</strong>at<strong>in</strong>g with a number of other organizations to hold acommunity forum on this issue. Date, time and location will be providedshortly. We are expect<strong>in</strong>g to hold this forum sometime the week of September8th (week follow<strong>in</strong>g Labor Day). q7
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