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Some state lawmakers want to put health insurance companies out of business, arguing that providing home health care is a failed experiment that costs states dearly and that they should pay for it directly.
When New York state reformed its state and federally funded Medicaid program in 2011, it allowed health insurance companies to begin managing home health care.
Thirteen years later, Senate Health Committee Chairman Gustavo Rivera says the policy has cost the state billions of dollars in unnecessary administrative costs and profits for insurance companies and must end. He said that there is.
“This is a failed experiment that has resulted in more than $6 billion in the last four years alone going into the pockets of insurance companies instead of into the pockets of care workers and long-term care providers.” ” Rivera said. “This bill would eliminate managed long-term care plans and return us to a state-managed fee-for-service model.”
Rivera said the bill, proposed in the Legislature by Health Committee Chairwoman Amy Paulin, would include a transition period to minimize disruption.
Managed Long Term Care Plans (MLTC) is fighting the bill by asking its contracted home care agencies to send letters to legislators expressing their opposition.
Alicia Laible-Kenyon is executive director of Elderwood Health Plan in Buffalo. The plan works with licensed home health agencies to provide home health care to vulnerable adults.
She said MLTC provides support beyond home health care by assigning beneficiaries a care manager. That could include referrals to physical therapy, free or subsidized meals, and other services that address the social determinants of health.
“Food security, housing stability, are they going to be able to turn off their electricity?” Laible-Kenyon said, adding that some older people are proud and don’t always want to share that they don’t have enough food or money. He added that there is.
“Our social workers are trusted over the long term,” she said. “Some of these members we have worked with for many years to find out what their real needs are.”
He said previous actions by the state health department have already cut in half the number of managed long-term care plans operating in the state, and the system needs to absorb those changes first.
Laible-Kenyon said she could not discuss how much insurance companies would charge for the service or how much the state would pay the MLTC. But she said home care workers must be paid at least minimum wage according to state law.
Damian Labella, a spokesperson for the New York State Federation of Managed Long-Term Care Plans, said each plan negotiates rates individually with care providers, and specific payment levels can vary widely based on several factors. He said the exact cost breakdown was “complicated” because of the .
Laible-Kenyon also attacked state lawmakers who support the MLTC repeal bill.
“Every few years you get a politician who really wants to make a mark and put their name on something,” she said. “They have submitted proposals that will actually cause massive disruption to our community. I’m not saying they’re doing it maliciously. But I’m not saying they’re doing it with malicious intent. I don’t think we fully understand what it is and what the negative effects of it are.”
Rivera said Laible-Kenyon’s criticism was “a very good theory.”
“But that ignores the fact that I’m not new here,” he added. “I’ve been here for 14 years. I’ve been chair of the health committee for six years.
Rivera said he has remained consistent in his views throughout that time.
“In that we should be investing in the system, not in corporate profits,” he said.
The bill comes as Gov. Kathy Hochul proposes cutting $1.2 billion from a popular home health program known as consumer-directed care. This program allows people with disabilities to hire their own home care workers and have more control over how their care is managed.
Rivera called the cuts “disconcerting” and said the budget would be restored in the Senate and Assembly budgets. He said the program, which doesn’t involve insurance companies, has virtually no overhead, so most of what recipients pay goes directly to home care workers.
The use of consumer care programs has increased significantly in recent years. Rivera said ending health insurance company involvement in the MLTC would save $1 billion to $2 billion a year and help pay for it.
Laible-Kenyon said her organization does not support the governor’s cuts to consumer care programs, adding that she believes the two approaches to home health care can coexist.
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