MMNY Sets 2014 Policy and Budget Agenda

NYAPRS Note: Medicaid Matters is a statewide, consumer-oriented organization that advocates on behalf of the Medicaid program and the persons it serves. NYAPRS is a MMNY Steering Committee member as well as a member of the Managed Care workgroup. Below, find the 2014 policy and budget priorities for the coalition as well as the MC workgroup. To find ways to assist MMNY or join them in their advocacy, visit them here.


1)Medicaid Matters 2014 Policy and Budget Agenda

The interests of people served by the New York’s Medicaid program are the focus of the advocacy of

Medicaid Matters New York (MMNY). For all New Yorkers, no matter their circumstances, the hallmark

of maintaining good health is accessibility.


Access to Coverage

• Implement a Basic Health Program

• Ensure cultural competency in all aspects of New York State of Health, including language

accessibility and general access for immigrants

• Integrate eligibility for non-MAGI and people using other public programs; train navigators and

provide adequate consumer information

• Improve the New York State of Health website and call center functions to promote general

accessibility and ease of use; increase marketing to low-income populations, and provide

information about Medicaid and all public programs available


Access to Services

• Enact and enhance strong consumer protections in Medicaid Managed Care and all models of

care management (see MMNY Managed Care Workgroup agenda)

• Address health disparities based on race, ethnicity, disability (physical, psychiatric, and

developmental), sexual orientation and identity, and any other circumstance; implement

recommendations previously submitted through MRT Health Disparities Workgroup and other


• Invest in community-based services and safety-net providers, particularly as needs will change

due to increase in people with insurance and shifts to new managed care models

• Invest in social determinants of health

• Ensure network adequacy in all care delivery models


Access to Consumer Assistance

• Provide funding for robust advocacy and assistance services for people with disabilities and

chronic needs in Medicaid managed care

• Continue funding for overall consumer assistance in New York State of Health, including after


• Provide specific funding for people with disabilities to access consumer assistance with eligibility

and enrollment, including after enrollment

• Mandate all consumer notices from the state and managed care plans be clear and standardized


Access to Information and Participation

• Guarantee transparency in the allocation of all Medicaid funding, particularly through new

funding mechanisms being considered with new waiver amendment application

• Include consumer advocates in the work and negotiations on waiver amendments, state plan

amendments, managed care contracts, and any other changes to the Medicaid program

• Increase funding for health information technology to support new and growing models of care


2)MMNY Managed Care Workgroup 2014-2015 Managed Care Budget Agenda

Eliminate exhaustion requirement for Medicaid recipients enrolled in Managed Long Term Care


The state requires dually-eligible Medicaid recipients enrolled in MTLC to “exhaust” all

internal appeals within their managed care plan before requesting a fair hearing when services are

denied, reduced or terminated. Federal regulations give states the option to require “exhaustion” of

internal appeals, but the Department of Health has imposed this requirement. This requirement

threatens to bar access to appeals for some of the most vulnerable Medicaid populations – seniors

and people with disabilities.


Repeal the policy that Medicaid recipients enrolled in MLTC are not entitled to Aid-Continuing


when the reduction coincides with the end of the plan’s authorization period

The right to notice and a hearing before reduction or termination of benefits is a fundamental

due process right. In the MLTC program, however, managed care plans may authorize Medicaid long

term care services with no advance notice and no right for the consumer to receive services while a

hearing is pending, if the plan’s service reduction coincides with the end of the plan’s “authorization

period” for the services.


Mandate all Medicaid managed care plans to use standardized notices created by DOH with

stakeholder input


Medicaid managed care plans are required to use notices that have been reviewed and

approved by DOH. The notices, however, are not uniform across type of care or plan. Some plans

include a list of appeal options that includes an external appeal with the New York State Department

of Financial Services, even though this is not available for all denials. Standardized notices would

reduce consumer confusion. The notices should be created with the assistance of literacy experts

and allow for stakeholder input. Denial and reduction notices should include information on how to

access legal representation and provide the information for complaint lines.


Require Medicaid managed care plans to provide an evidence packet to an appellant when a

hearing is requested


When an enrollee requests a fair hearing, the Medicaid managed care plan creates an

evidence packet in preparation for that hearing. The plans should be required to automatically

forward a copy of that evidence packet to the appellant.


Require Medicaid managed care plans to provide access to utilization data


Medicaid managed care plans are required to maintain a health information system that

collects, analyzes, integrates, and reports data, including but not limited to utilization data. It is

important that beneficiaries and their advocates have access to this data. The state should require

the plans to release utilization records to Medicaid members and, with a member’s permission, to

their advocates.


Expand the Medicaid Managed Care Ombudsman Program


As mandatory enrollment into Medicaid managed care expands to people who have

historically been exempt or excluded, there will be a significant need for individual, independent

assistance for people as they enroll, attempt to access services, and navigate the complexity of

managed care. The Medicaid Managed Care Ombudsman Program will be available across the state

to fund such assistance. The state should increase funding to the program to allow it to reach

capacity and be available as more people are enrolled in Medicaid managed care.


Expand the Medicaid Managed Care Advisory Review Panel


As the only statutorily-required forum for stakeholder input regarding Medicaid managed care

issues, MMCARP membership should reflect a strong voice for Medicaid consumers, who are the

most vulnerable and most directly impacted by policy changes to the Medicaid program. As Medicaid

managed care is expanded to populations not previously required to enroll, such as people with

disabilities and long-term, complex needs, MMNY urges DOH to expand membership from the

consumer advocate community.