Medicare News
| For Immediate Release: | Contact: |
| Tuesday, July 15, 1997 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
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HCFA APPROVES LARGEST-EVER MEDICAID WAIVER FOR NEW YORK
The Health Care Financing Administration (HCFA) today announced approval of a Medicaid demonstration proposal allowing New York state to enroll more than 2.4 million people in managed care plans.
This demonstration, the largest ever approved by HCFA, will include coverage for 370,000 people not currently enrolled in Medicaid.
The demonstration is tailored to provide specific protections for people with special health care needs, to promote inclusion of traditional "safety net" providers in managed care networks, and to give the state flexibility to implement its transition to managed care.
"This project demonstrates the Clinton Administration's commitment to work closely with states," said Health and Human Services Secretary Donna E. Shalala. "The waiver contains strong protections for Medicaid's most vulnerable recipients, including adults and children with special needs, pregnant women, and people with HIV/AIDS. We have also worked to ensure that hospitals that provide care to our most vulnerable citizens can make a smooth transition to managed care."
The demonstration covers 2.1 million currently eligible individuals and approximately 370,000 Home Relief (General Assistance) beneficiaries who are not now eligible for Medicaid. They will, through enrollment brokers, choose among two or more managed care plans.
The plans will offer a comprehensive benefits package covering all services currently provided in the state's Medicaid program, with exceptions for certain services like nursing home care, which will continue to be provided on a fee-for-service basis.
Fully-capitated Special Needs Plans are being established for people whose care requires intensive case management -- individuals with HIV/AIDS, seriously and persistently mentally ill adults, and seriously emotionally disturbed children. Special quality assurance standards and performance measures are being developed for Special Needs Plans.
A program to assist "safety net" hospitals that traditionally served Medicaid populations is also incorporated into the demonstration. This Community Health Care Conversion Demonstration provides up to $250 million each year for five years to support work force restructuring as these providers make the transition to a managed care environment.
"Developing a demonstration this complex for a state this large has been especially challenging and rewarding," said Sally Richardson, director of HCFA's Center for Medicaid and State Operations. "We look forward to continued collaboration with the State and advocacy groups to make sure that it is implemented with as much care as it has been crafted."
The Clinton Administration has now approved sixteen such Medicaid waivers allowing states to enroll beneficiaries in managed care plans. When fully implemented, these waivers will extend coverage to more than 2 million people who had not previously been eligible for Medicaid.
