Health Advocates Attack Long Term Care Plans for Cutting Care to Patients

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The New York Times reported last week (July 20 story by Nina Bernstein) that some managed long term care insurance plans (MLTCs) operating for Medicaid patients arbitrarily reduced the number of hours of care to some of the most vulnerable and high cost aged and disabled patients.  Most of the complaints centered on a few plans.  56% of the complaints were about Senior Health Partners of Health First in the New York City area.    In fair hearings over 80% of these cuts were reversed.

Health advocates in the Medicaid Matters NY coalition of over 100 nonprofit organizations issued a report saying the reversal of these cuts indicates that some of these MLTC plans were arbitrarily reducing home care hours for clients.  The Times story profiled a woman whose weekly hours were cut from 50 to 25.   The plans have argued that managed long term care was designed to reduce expenditures on high cost users.  However, the plans are also supposed to be “managing” the client’s care and maintaining quality not just cutting hours and costs.  Many persons like the woman profiled are left struggling to find a way to manage without the help they have had.   A lawsuit is also being filed by elder law attorneys on behalf of some clients against their managed care companies.

The state has moved in recent years to require most Medicaid beneficiaries needing long term care to enroll in managed care plans or be automatically placed in one.  Advocates have expressed concerns from the beginning that this new policy was untested and that there are dangers that could result in many clients losing care in order to lower costs. The financial incentives in the program favor cost cutting:  plans are generally paid a set rate  and they can save what isn’t spent.  The state has argued that care would be better managed and beneficiaries would get more comprehensive care.  That may be true if plans do it right but it is costly to provide all the care needed and some companies that tried to provide extensive services like Senior Whole Health went out of business in some upstate areas.

The state says that 87% of those in managed long term care expressed satisfaction in surveys they have done.  That number may not show those who haven’t responded or are too ill to respond.  And, even 13% of people being dissatisfied is not acceptable if their health care has declined or been threatened with cuts.

This is an unacceptable situation that was predictable when you put the most vulnerable with the highest costs under a system that financially  rewards plans  for less care and allows for arbitrary and capricious cost cuts.  The state likes to pride itself on changing health services to an “evidence based” model that requires state money spent to prove that it has been effective in meeting its stated goals.  Perhaps there are some efficiencies that can be achieved with managed long term care but where is the care coordination and “evidence based” component of these decisions that proves that all of these plans are maintaining or improving the quality of care?

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I have been a senior advocate for most of my career. I was Executive Director of the New York StateWide Senior Action Council and the New York State Alliance for Retired Americans. In 2007-2010 I was the Director of the New York State Office for the Aging

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