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
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.