INTRODUCTION TO MANAGED CARE FOR MEDICAID RECIPIENTS

New York State is working to improve the quality of care that patients receive and reduce health care costs, especially for individuals who utilize the Medicaid system. The goal is that all those who receive Medicaid benefits will be enrolled in a care management system.

Managed Care is a type of health insurance plan or health care system that includes coordination of services. In other words, helps you organize and get things taken care of. A care manager works for a “health home” or for the insurance plan. They consult with the individual and their family members and/or the people who know the person best, to ensure the individual receives primary and preventive services.

When appropriate they can coordinate care between providers. Managed care also improves communication and information technology.

Health care providers will no longer bill New York State directly with fees for each service. Instead a managed care organization (MCO) will be paid a fixed amount by New York State for the person’s care. The MCO is responsible for managing care with the patient and paying the service providers.
OPWDD and the State continue to work with stakeholders to ensure quality of care for all individuals.
Specifics on what services are included and timeframes are currently under discussion and we will keep you informed once they have been defined.