Proposal Presented for the Master Plan for Aging (#86)
Disclaimer
Throughout the MPA process, more than 100 proposals were developed thanks in particular to thousands of hours of work by external stakeholders and members of the public. These proposals and the MPA Council commentary are being submitted to the Governor and shared with policymakers and the public to inform policymaking. These proposals represent a starting point for discussion. Further discussion is necessary between relevant state agencies and stakeholders to both refine these proposals and assess which may be appropriate to adopt and implement.
Summary
Create ways to upscale service delivery to the most integrated settings possible. Incorporate enrollees who receive services through provider programs without coordination and aging individuals receiving OPWDD services into more comprehensive programs, such as PACE, without disenrollment or automatic exclusion from their current program. These changes ensure more holistic care coordination.
Justification
New York State policy supports enrollment of dually eligible individuals into fully aligned Medicare-Medicaid arrangements such as PACE. However, in practice, New York’s delivery system has a path of least resistance to less integrated care options and several barriers exist in enrolling dually eligible individuals into integrated care. These barriers include: the current exclusion from PACE of those enrollees’ receiving services through the Medicaid Assisted Living Program (ALP) or OWPDD, consumer protections that prohibit automatic enrollment of newly Medicare eligibles into PACE, poor representation of PACE in plan to plan transfers and OPWDD I/DD and OALTC LTC regulations that inhibit the I/DD providers from caring for individuals with I/DD as they age and become more frail.
Full Proposal
Aging individuals should be enrolled in the most integrated Medicaid-Medicare services available. Many aging dually eligible individuals with LTSS needs are eligible for PACE but are currently enrolled in another program that provides benefits in a piecemeal approach. To better execute on State policy of expanding access to benefits of duals care integration, NYS should create ways to upscale service delivery to the most integrated settings possible. Enrollees who receive services through narrow provider programs without coordination, such as aging individuals in an Assisted Living Program or receiving OPWDD services, should be guided towards more comprehensive programs, such as PACE, without disenrollment or exclusion from their current program to ensure more holistic care coordination.
MPA Council Commentary
This proposal is categorized as long-term. The State has taken many steps to promote greater integration of care between Medicaid and Medicare. Policymakers may reference this proposal during the legislative session, as development of a new path for enrollment in integrated care programs could require legislative action. The first step to implement this proposal would be to conduct an evaluation of the range of enrollees negatively affected by current rules and evaluate the fiscal impact of the proposed changes. Decisions about expanding access to Medicaid programs are made in the context of the annual budgeting process and the Medicaid Global Spending Cap are subject to the availability of resources.