Mandatory Managed Care in New York State Nursing Homes: A Review and Assessment of Current Access & Quality as the State Mandates Medicaid Managed Long Term Care for Nursing Home Residents

Posted on: 2013-10-15 15:23:50

Report: Mandatory Managed Care in NY State Nursing Homes

Executive Summary


Chart: Nursing Homes in MLTC 2013

Chart: MLTC Rankings for Nursing Home Quality 2013

Chart: Nursing Homes in Managed Long Term Care With All Quality and Plan Information

LTCCC Comments on LTC Ombudsman Rules

In possibly the most significant development in nursing home care since passage of the federal Nursing Home Reform Law in 1987, New York is transforming the way frail elderly and disabled individuals access nursing homes. Starting in January 2014, the state is going to begin its plan to mandate that everyone in Medicaid who needs nursing home care access this care through a private Managed Long Term Care (MLTC) insurance plan.

This will directly affect the overwhelming majority of nursing home residents (since Medicaid is the primary payer of nursing home care). Roll out of the transition will take at least two years and will not affect people who are already in nursing homes, whose care will continue to be paid via traditional Medicaid “fee for service.”

A note on how to use this report.

New York has the largest nursing home population of any U.S. state, and the move to Mandatory Managed Long Term Care will be a seismic shift for New Yorkers who need nursing home care, and their families, for many years to come. To provide a framework, this report begins with a brief review of issues relevant to nursing home care and managed long term care (MLTC) for nursing homes. Following this background, we have ‘crunched the numbers’ in various ways in order to provide useful information and insights into the current state of nursing homes in MLTC, and its implications for communities across the state.

To facilitate use of the information in this report, the Table of Contents contains internal links; by clicking on a page number the reader should be able to go directly to the page of interest. Chapter VI provides information on how the nursing homes that are currently in MLTC are performing, as a whole, on the parameters we identified as being strong indicators of whether or not a nursing home is providing good care. Chapter VII addresses access to nursing homes. This is a central issue since, while New Yorkers on Medicaid (including those on both Medicare and Medicaid) will be required to join an MLTC plan, the MLTC plans will not be required to contract with all nursing homes in their service areas.

This in turn raises perhaps the most important question for New Yorkers: since MLTC plans do not have to contract with any willing nursing home provider, what is there to stop the plans, which have their own expenses, profit goals and ‘bottom lines’ to meet, from only contracting with the cheapest nursing homes? The answer, in short, is not much. In the absence of standards to ensure that MLTC plans don’t send people to the cheapest nursing homes (which are likely to be spending the least on staffing and other resident care costs), we believe it is important to shed light on the quality of nursing homes that the individual plans are choosing. Thus, Chapter VIII provides information on the individual MLTC plans and the quality of their nursing homes, including rankings of the plans on each of the selected indicators, and Chapter IX provides information on nursing homes across the state that have serious and known problems, but with which the plans are contracting to care for their beneficiaries. Recommendations for improving quality, access and the efficient use of public funds that pay for this care are provided in Chapter X.

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