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N.Y. Waiver Program Aims at Dual Eligibility

MANAGED CARE February 2012. © MediMedia USA
News & Commentary

N.Y. Waiver Program Aims at Dual Eligibility

MANAGED CARE February 2012. ©MediMedia USA

New York state would seek a waiver from the Centers for Medicaid & Medicare Services to contract with health plans to cover people who are eligible for both Medicaid and Medicare, under a new proposal. The state’s 700,000 dual-eligibles consume about 45 percent of Medicaid and 41 percent of Medicare spending. A proposal by the state’s Department of Health would allow the state to deal with plans and accountable care organizations under subcapitation arrangements (http://bit.ly/sAQgEG).

The report outlining the recommendations points out that New York’s PACE (Programs of All-Inclusive Care for the Elderly) enrollment is the highest in the country and that the state’s Medicare Advantage Plus program was one of the first to contract with a health insurer that covers both Medicaid and Medicare beneficiaries.

Now, however, state officials say that growing enrollment has made the programs less functional.

Under the proposal, “New York would partner through ‘sub-capitation arrangements’ with health plans and/or integrated provider groups that have sufficient network capacity and are capable of delivering care and assuming risk for the full spectrum of Medicare and Medicaid covered services.”

State officials claim that everybody wins: Members will have access to better care, the federal government will spend less, and state providers and health plans will be able to “share in savings that result from care integration.”

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