A Plan to Transform the Empire State s Medicaid Program. 2013: The Year Ahead in Medicaid Redesign

Transcription

1 Redesign Medicaid in New Yrk State A Plan t Transfrm the Empire State s Medicaid Prgram 2013: The Year Ahead in Medicaid Redesign May 17, 2013 Jasn A. Helgersn, Medicaid Directr NYS Department f Health 2013 Pririties Pririty 1: Cntinue implementatin f MRT refrms. Pririty 2: Gain CMS apprval f the MRT waiver amendment. Pririty 3: Prepare t launch the FIDA demnstratin. Pririty 4: Get the financial challenges assciated with the DD system behind us. Pririty 5: Prepare fr ACA implementatin and begin state takever f Medicaid Administratin. Redesign Medicaid in New Yrk State 2 1

2 Pririty 1: Cntinue MRT Implementatin The MRT actin plan will take a full five years t implement. Implementatin f Care Management fr All cntinues in 2013: Transitin Cmmunity placed nn per diem Fster Care Children int Managed Care (April 2013); Transitin LTHHCP int Managed Care; Transitin the Nursing Hme ppulatin (nn duals) int MMC (Octber 2013); Launch Special Needs Plans fr peple with significant and persistent mental illness. Redesign Medicaid in New Yrk State 3 Pririty 1: Cntinue MRT Implementatin Cmplete the statewide implementatin f the transprtatin management initiative. Cntinue statewide rle ut f health hmes. By April f 2013 we expect 76,000 enrlled and by April f 2014 we expect 151,000 will be enrlled. Launch ACO s statewide. Launch a new emergency rm triage initiative t reduce inapprpriate ER utilizatin and increase use f primary care. Redesign Medicaid in New Yrk State 4 2

3 Pririty 1: Cntinue MRT Implementatin Fund additinal supprtive husing effrts targeted at high needs Medicaid members. Cntinue t drill dwn int the Medicaid benefit package and prpse additinal benefit changes t ensure Medicaid members access the mst cst effective treatments. Implement the Vital Access Prvider (VAP) prgram t assist vulnerable safety net prviders transitin t mre sustainable business mdels that ensure access t essential services. Redesign Medicaid in New Yrk State 5 Pririty 2: MRT Waiver Amendment We currently have a waiver amendment pending with CMS that wuld allw us t reinvest $10 billin in MRT generated federal savings back int New Yrk s health care delivery system. The amendment is essential t bth fully implement the MRT actin plan as well as prepare fr ACA implementatin. The amendment, which requires federal apprval, is a unique pprtunity t address the underlying challenges facing NYS health care delivery: Lack f primary care; Weak health care safety net; Health disparities; and Transitin challenges t managed care. Redesign Medicaid in New Yrk State 6 3

4 MRT Waiver Reinvestment Strategies Primary Care Expansin ($1.25 billin ver the next five years). Health Hme Develpment ($525 millin ver the next five years). New Care Mdels ($375 millin ver the next five years). Expand Vital Access/Safety Net Prgram ($1.5 billin ver the next five years). Public Hspital Innvatin ($1.5 billin ver the next five years). Medicaid Supprtive Husing ($750 millin ver the next five years). Lng Term Transfrmatin Integratin t Managed Care ($839.1 millin ver the next five years). Redesign Medicaid in New Yrk State 7 7 MRT Waiver Reinvestment Strategies Capital Stabilizatin fr Safety Net Hspitals ($1.7 billin ver the next five years). Hspital Transitin ($520 millin ver the next five years). Ensuring the Health Wrkfrce Meets the Needs in the New Era f Health Care Refrm ($500 millin ver the next five years). Public Health Innvatin ($395.3 millin ver the next five years). Reginal Health Planning ($25 millin n average annually ver the next five years). MRT and Waiver Evaluatin Prgram ($500 millin ver the next five years). Redesign Medicaid in New Yrk State 8 4

5 Pririty 3: FIDA Demnstratin A key step in the mve t care management fr all is the prpsed Fully Integrated Dual Advantage (FIDA) demnstratin prject. Thrugh this effrt 120,000 dually eligible members (Medicaid and Medicare) will be enrlled int full integrated managed care prducts. The enrllment prcess will rely n a cnversin in place apprach under which duals enrlled in MLTCP plans will see their Medicare benefit added t their managed care plan s prtfli. Members will be able t p ut f the Medicare managed care prduct. Implementatin = January 2014 Redesign Medicaid in New Yrk State 9 Pririty 4: Get the DD Financial Prblems Behind Us The current system fr financing services fr develpmental disability services is n lnger apprpriate and needs t be replaced. Replacing the system is cmplex and billins f dllars are at risk if the state can t replace the system in a timely and reasnable fashin. The state is wrking with CMS t adjust rates and implement DD system refrms that will bth lwer federal csts fr the system as well imprve patient utcmes. Redesign Medicaid in New Yrk State 10 5

6 Pririty 5: ACA Implementatin & Medicaid Administratin Refrm The Affrdable Care Act (ACA) is a tremendus pprtunity fr New Yrk State: 1 millin New Yrkers will gain access t health insurance; Additinal federal financing fr Medicaid will help ensure prgram sustainability; Building a new health insurance exchange will allw the state t phase ut the ut f date WMS eligibility system. New Yrk will perate its wn exchange and will use the launch f the exchange t als facilitate the state takever f Medicaid administratin frm cunties. Redesign Medicaid in New Yrk State 11 Pririty 5: ACA Implementatin & Medicaid Administratin Refrm State take ver will prvide cunties with mandate relief and create greater cnsistency in custmer treatment acrss the state. Full state takever will take five years t implement. Standing up the exchange by Octber 1, 2013 is a majr challenge fr DOH and ur partners. Lts f wrk ahead! Redesign Medicaid in New Yrk State 12 6

7 Next Steps Thanks t the MRT we nw have a multiyear actin plan, a radmap, fr meaningful Medicaid refrm. Need t get the MRT waiver amendment apprved. Need t cntinue t implement MRT actin plan. Biggest risks are cntinued enrllment grwth and ptential federal cuts in Medicaid/Medicare. Redesign Medicaid in New Yrk State 13 Cntact Infrmatin We want t hear frm yu! MRT website: mrtwaiver@health.state.ny.us Subscribe t ur listserv: Like the MRT n Facebk: Fllw the MRT n Redesign Medicaid in New Yrk State 14 7