New Ruling Promises To Improve Medicaid Managed Care Programs

Medicaid is the government program that helps offset medical costs for those showing a low amount of income. As part of managing your care as you get older, there are a variety of options to help you qualify for this program, without having to first deplete your life savings paying for medical or nursing home care costs yourself. While Medicaid has fallen under fire in recent years for administrative waste and low quality and access to services, Medicaid planning continues to play an important role in overall asset management for many Americans. Fortunately, a new ruling promises to help improve the program while making it easier for clients to get the care and service they need.

Medicaid Managed Care

According to the Centers for Medicare and Medicaid Services, the Medicaid managed care program is designed to help decrease costs while increasing the overall quality of service Medicaid recipients receive from providers. Through agreements between state Medicaid agencies and Managed Care Organizations (MCO), care is provided for a set payment each month, based on both the individual member and the month in which they receive services. New York’s Medicaid Managed Care Program serves roughly two thirds of all state Medicaid recipients, and offers the following types of services:

• Primary care, which is a basic level of healthcare designed to maintain health and wellness;
• Specialty care, which provides management and treatment for a variety of illness and chronic conditions;
• Acute care, which provides treatment for severe injuries and illnesses;
• Limited long term care, which provides limited coverage for nursing homes or home health care following an illness;
• Limited behavioral health, which provides limited access to mental health services.

In addition to the above, New York also offers the Managed Long Term Care (MLTC) program, which offers institutional and community support services for eligible recipients.

Improvements To Medicaid Managed Care

Despite the benefits the Medicaid Managed Care program promises, there have been increasing complaints in recent years concerning program mismanagement and waste, while clients complain of difficulties in receiving care and a general lack of providers. In April 2016, the U.S. Department of Health and Human Services issued a ruling designed to overhaul the system and deliver better care while improving program accountability. Improvements the overhaul hopes to make include:

• Improved patient access to medical care, services, and doctors;
• Improved coordination of care among different providers;
• Increased support for patients and families receiving long term care services;
• Improved process for requesting program and benefit information and for filing complaints;
• Increased client rights in terms of appealing eligibility decisions.

How Our New York Medicaid Attorneys Can Help

If you need help or have questions about obtaining Medicaid, or have concerns about the types or quality of services you are receiving, contact our experienced New York Medicaid attorney today. At Cavallo & Cavallo, we can advise you on how to increase your Medicaid eligibility without draining your resources, while helping you get the medical care and attention you deserve.

Resources:

medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html

medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/downloads/new-york-mcp.pdf