Memorandum in Support
For Immediate Release:   February 9, 2024

Re:      S.2867 (Rivera)/A.7369 (McDonald) – AN ACT to amend the social services law, in relation to the provision of services to certain persons suffering from traumatic brain injuries or qualifying for nursing home diversion and transition services

The New York Health Plan Association (HPA) supports S.2867/A.7369, which would permanently carve out individuals served by the nursing home transition diversion (NHTD) and traumatic brain injury (TBI) waivers from the Medicaid managed care program, and directs the Department of Health to seek the necessary approvals from the federal government.

As part of the work of the Medicaid Redesign Team (MRT), the state proposed to move individuals currently served by NHTD/TBI waivers into Medicaid managed care.  As a result of this, both existing 1915(c) Medicaid waivers would then be discontinued.  Due to concerns raised by consumers and providers over the past several years regarding the lack of a detailed transition plan, the Department of Health (DOH) agreed to delay the transition until at least January 2026.  S. 2867/A.7369, would keep the current system in place.

Since that time, issues still remain unresolved; leaving HPA to conclude that the transition of these populations into Medicaid managed care is not in the best interest of the waiver participants – or the providers or the plans.

HPA has serious concerns that approximately 28 percent of individuals currently served by the TBI waiver would not meet managed long-term care (MLTC) eligibility standards and would therefore be at risk of losing the services that allow them to remain at home.  The issue would be exacerbated once the state statute to limit MLTC eligibility to those individuals in need of assistance with at least two activities of daily living (ADLs) is implemented after the end of the public health emergency.  Additionally, spreading a relatively small (fewer than 6,000 individuals), but geographically dispersed population with high needs across more than one dozen plans is not an effective way to provide the highest quality and most cost-effective care to this population.

For these reasons, HPA supports the carve out of this population from Medicaid managed care. We believe they will be better served through continuation of existing waiver programs.