Laura
08-01-2011, 10:20 AM
Changes to Medicaid Managed Care
This year's state budget made many changes to Medicaid. Beginning 8/1/11, personal care services will now be included in the Medicaid managed care benefit package. This means that people in Medicaid Managed Care Plans will have their Personal Care Services (or home attendants) authorized by their Plan rather than be approved by their local Medicaid office (HRA's CASA). This change will affect about 3,000 people in New York City, mostly SSI recipients. It does not apply to people who receive both Medicare and Medicaid (dual eligibles) and people with a spend-down. People enrolled in Consumer Directed Personal Care will not be affected by these changes until 7/1/12. As proposed, the plan must continue the same amount of services previously authorized, but only for a transition period while the plan re-assesses your need for services.
In October, prescription drugs will be included in managed care. While managed care plans will be required to provide coverage for those categories of drugs currently included in the fee for service program, they do not have to cover a specific drug and can include restrictions such as "prior approval" and quantity limits for covered drugs. Medicaid Managed Care recipients will receive a letter from Medicaid this month followed by letters from their Plan explaining the change. Watch your mail and be sure to open these letters and find out if your pharmacies and drugs are covered by your plan. You may need to switch plans and there will be a way to appeal if a drug is not covered. If you have questions or need further information, contact Community Health Advocate Greg Otten at gotten@cidny.org or 646.442.4145 for advice and help.
This year's state budget made many changes to Medicaid. Beginning 8/1/11, personal care services will now be included in the Medicaid managed care benefit package. This means that people in Medicaid Managed Care Plans will have their Personal Care Services (or home attendants) authorized by their Plan rather than be approved by their local Medicaid office (HRA's CASA). This change will affect about 3,000 people in New York City, mostly SSI recipients. It does not apply to people who receive both Medicare and Medicaid (dual eligibles) and people with a spend-down. People enrolled in Consumer Directed Personal Care will not be affected by these changes until 7/1/12. As proposed, the plan must continue the same amount of services previously authorized, but only for a transition period while the plan re-assesses your need for services.
In October, prescription drugs will be included in managed care. While managed care plans will be required to provide coverage for those categories of drugs currently included in the fee for service program, they do not have to cover a specific drug and can include restrictions such as "prior approval" and quantity limits for covered drugs. Medicaid Managed Care recipients will receive a letter from Medicaid this month followed by letters from their Plan explaining the change. Watch your mail and be sure to open these letters and find out if your pharmacies and drugs are covered by your plan. You may need to switch plans and there will be a way to appeal if a drug is not covered. If you have questions or need further information, contact Community Health Advocate Greg Otten at gotten@cidny.org or 646.442.4145 for advice and help.