Imposing Mandatory Managed Care Enrollment Among HIV-Positive Medicaid Beneficiaries

Armen Hareyan's picture

New YorkGov. Eliot Spitzer (D) is considering imposing mandatory managed careenrollment among Medicaid beneficiaries who are living with HIV/AIDS, the New York Sun reports. Since the late 1990s, the state's65,000 people living with HIV/AIDS who are enrolled in New York's Medicaid have been exempt from astatewide enrollment drive to place beneficiaries into managed care plans, the Sunreports. About 10,000 HIV-positive beneficiaries are enrolled in Medicaidmanaged care plans.

Spitzer officials said the plan to mandate managed care enrollment amongHIV-positive Medicaid beneficiaries is in its beginning stages and might offera better value for Medicaid spending. "One reason we want to start adiscussion is because the data we have, across the board for Medicaid managedcare, shows that enrollees are getting better care than infee-for-service" plans, Deborah Bachrach, the state's Medicaid director,said. She added, "We can't make a decision without looking at costsavings. ... We can't just look at cost. What is the care we're buying?"According to the Sun, a "central question" to mandatoryenrollment is whether people living with HIV/AIDS would need to enroll inexisting Medicaid managed care plans, known as HIV Special Needs Plans.


Michael Kink -- legislative counsel for Housing Works, an HIV/AIDS service and advocacy group --said, "Simple mandatory enrollment in Medicaid HMOs is not any kind ofmagic bullet," adding that mandatory enrollment has "the potentialfor large-scale disruption of the HIV care system." Some HIV/AIDSadvocates questioned if HMOs could handle the unique needs of people livingwith the disease and if there are enough physicians specializing in HIV/AIDS.They also questioned whether the state's three HIV Special Needs Plans -- whichcurrently have 2,500 members and are available only in New York City -- could absorb the influx ofmembers. Doug Wirth -- president and CEO of New York City-based VidaCare, which offers an HIV Special Needs Program -- said the company's "special needsprogram would definitely need to expand its provider network in order to beresponsive to large numbers of people who would choose" the company(Solomont, New York Sun, 11/30).

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