New York Gov. Spitzer Considers Imposing Mandatory Managed Care Enrollment Among HIV-Positive Medicaid Beneficiaries

Main Category: HIV / AIDS
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 04 Dec 2007 - 12:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

New York Gov. Eliot Spitzer (D) is considering imposing mandatory managed care enrollment among Medicaid beneficiaries who are living with HIV/AIDS, the New York Sun reports. Since the late 1990s, the state's 65,000 people living with HIV/AIDS who are enrolled in New York's Medicaid have been exempt from a statewide enrollment drive to place beneficiaries into managed care plans, the Sun reports. About 10,000 HIV-positive beneficiaries are enrolled in Medicaid managed care plans.

Spitzer officials said the plan to mandate managed care enrollment among HIV-positive Medicaid beneficiaries is in its beginning stages and might offer a better value for Medicaid spending. "One reason we want to start a discussion is because the data we have, across the board for Medicaid managed care, shows that enrollees are getting better care than in fee-for-service" plans, Deborah Bachrach, the state's Medicaid director, said. She added, "We can't make a decision without looking at cost savings. ... We can't just look at cost. What is the care we're buying?" According to the Sun, a "central question" to mandatory enrollment is whether people living with HIV/AIDS would need to enroll in existing Medicaid managed care plans, known as HIV Special Needs Plans.

Michael Kink -- legislative counsel for Housing Works, an HIV/AIDS service and advocacy group -- said, "Simple mandatory enrollment in Medicaid HMOs is not any kind of magic bullet," adding that mandatory enrollment has "the potential for large-scale disruption of the HIV care system." Some HIV/AIDS advocates questioned if HMOs could handle the unique needs of people living with the disease and if there are enough physicians specializing in HIV/AIDS. They also questioned whether the state's three HIV Special Needs Plans -- which currently have 2,500 members and are available only in New York City -- could absorb the influx of members. Doug Wirth -- president and CEO of New York City-based VidaCare, which offers an HIV Special Needs Program -- said the company's "special needs program would definitely need to expand its provider network in order to be responsive to large numbers of people who would choose" the company (Solomont, New York Sun, 11/30).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved