The New York State Department of Health has agreed to a deal with Independence Care System to wind down its managed long-term care plan by March 31 and transition members to a different insurer.
If ICS' about 5,800 MLTC members do not pick a new plan by April 1, they automatically will be enrolled in VNSNY Choice, the MLTC plan of the Visiting Nurse Service of New York. Members who join VNSNY Choice will be "guaranteed the same level of services they currently receive for one year," ICS said. Members who pick a different plan are eligible to maintain their same level of service for 120 days.
As part of its deal with the state, ICS said it will create the state's first health home for people with physical disabilities. The Medicaid Health Home program coordinates care for people with multiple chronic illnesses, HIV/AIDS or a serious mental illness. ICS, which serves members in the Bronx, Brooklyn, Manhattan and Queens, will apply that model to people with physical disabilities, coordinating their care but no longer acting as the insurer that approves and pays for their services.
"DOH worked with us over many months to ensure that we will be able to use the specialized knowledge and skills we have developed to continue serving New Yorkers with disabilities," Regina Estela, ICS' chief operating officer, said in a statement.
The arrangement will allow for continuity of services, said state Medicaid Director Donna Frescatore.
"That's a really important agreement," she said. "Consumers will be able to continue to access a care manager they trust and have a longstanding relationship with."
Independence Care System, founded in 2000, specializes in providing coverage to people with physical disabilities and had struggled financially due to the more intensive services required by its members. ICS has a significant portion of members requiring 12- or 24-hour care by home health aides, according to disability advocates. The state's managed long-term care program is designed to provide nursing home–level care to people who are chronically ill or disabled with the goal of allowing them to remain at home.
"Caring for a high proportion of members with significant to severe disabilities made it increasingly fiscally unsustainable for ICS to continue as an MLTC plan," ICS said in its announcement.
Frescatore said the premiums VNSNY Choice receives will be adjusted to reflect the financial risk of new members. She said it would be more financially feasible for VNS Choice, which had about 13,200 members as of December, to manage ICS' members.
"The risk of the population will be spread over more members, who have more diversity in need," she said.
Alex Elegudin, co-founder and president of the advocacy organization Wheeling Forward, said he was disappointed that the state did not increase reimbursement to ICS so it could continue to operate as an insurer.
He said he hopes the state Department of Health would monitor former ICS members to see whether the rates of nursing home use and hospitalizations are affected by the transition.
"I wish we would've had a long-term solution, not a short-term transition," he said. "In a year, we will need an army of lawyers to help individuals protect their services."
"Health plan for the disabled to shut down" was originally published in Crain's New York.