Medicaid and Child Health Plus
New York’s managed care plans have been a strong partner with the state for nearly 30 years. Together, the state and plans have worked to expand coverage and improve quality of care for lower income and underserved populations. More than five million New Yorkers are enrolled in managed care plans through a variety of government-sponsored programs such as Medicaid Managed Care, Child Health Plus and New York’s Essential Plan. The following member* stories offer real examples about how plans support the health care needs of theses members.
* Some names have been changed to protect member privacy
During her first pregnancy, Chelyssa experienced dangerously high blood pressure and a premature delivery. Her doctors told her if she got pregnant again, she would need specialized care.
Adult Health NP House Calls
Dr. Willa Arnet started Adult Health NP House Calls to bring care directly to people when they are unable to leave home. Focusing on Medicaid beneficiaries who have not recently used the health system, she provides in-home visits with a comprehensive physical exam.
Manny is one of the more than 390,000 children in New York who have asthma. Although there is no cure for asthma, proper care and treatment can help control it and prevent attacks. Empire Blue Cross Blue Shield’s “Improving Asthma” program, a partnership with the New York City Department of Health and Mental Hygiene, is working to address childhood asthma and improve treatment outcomes.
In 2021, Paul, a Fidelis Care Medicaid member, was homeless, coping with diabetes and struggling with food insecurity. The Fidelis Care SOAR (SSI Outreach, Access, and Recovery) program was there to help with Community Relations Specialists who engage with the most vulnerable populations, providing support and assistance.
Tiana, a 26-year-old Fidelis Care Medicaid member, was not working after having her second child and needed financial assistance to help pay for food, rent, and utility bills. When Maureen, a licensed master social worker, learned that, she worked with Tiana to help her apply for and receive assistance through WIC, HEAP, and SNAP. That help enabled Tiana to provide food and formula for her 2 children and pay her heating bill.
At 85, Mickey L., a former jazz drummer, continues to give back to his community, volunteering at the youth music program of a local school three times a week. However, because he lives alone in a senior apartment complex and has multiple chronic conditions, accessing care is often a burden.
When Jillian M.’s three-year-old daughter got sick in September 2021, she thought it was just a cold. The little girl, Nala, had tested positive for COVID-19 five weeks prior, but experienced no symptoms at the time. Nala is covered by Child Health Plus (CHP), and her care is overseen by CDPHP, one of New York’s managed care health plans.
James P.*, a 63-year-old member with behavioral health needs, came to the attention of the Empire BCBS HealthPlus case management team following a behavioral health hospitalization.
Will S*. is an Empire BCBS HealthPlus member diagnosed with severe asthma, requiring regular albuterol treatments. He also had transportation issues because his parents are very sick and could not take him to see his providers regularly. As a result, he ended up in the emergency room twice in 2020, and ended up being admitted for asthma related symptoms.
Maria C.*, a 27-year-old Spanish-speaking member, was an expectant first-time mother, working part-time at a local restaurant. She was experiencing feelings of stress and occasional hopelessness, especially since her baby’s father and her immediate family resided outside of the U.S. At 21 weeks into her pregnancy, Maria met with Empire’s case management team, forging a connection that would change her and her baby’s life.
Before connecting with the Empire Case Management team, Marie P.*, 63-years old, had experienced homelessness for almost four years. Marie has a host of mental and physical health complications, including major depressive disorder, opioid related disorders, generalized anxiety disorder, PTSD and borderline personality disorder. She also suffers from high blood pressure, chronic ischemic heart disease, High LDL and type 2 diabetes.
Jane L. is a 63-year-old English speaking female MetroPlusHealth Medicaid member who also has a history of type 2 Diabetes, hypertension and high cholesterol as well as tongue cancer. When a MetroPlusHealth care manager connected with Jane to support her transition back to her home after being discharged from the hospital, the care manager realized Jane did not have reliable transportation to appointments.
The Shelby Family
The five members of the Shelby family, all MetroPlusHealth Medicaid members, have unfortunately experienced longstanding homelessness, moving in and out of Department of Homeless Services shelters since 2017.
When Veronique B. was admitted to the hospital her blood glucose and A1C levels were extremely high. The 47 year old, a member of Molina Healthcare of NY, also weighed 286 pounds at the time and was diagnosed as diabetic.