A broad group of stakeholders from across New York on Thursday sent a letter to the state Senate and Assembly Health Committee chairs, asking them to drop their support for a bill to replace the state’s managed long-term care programs with a fee-for-service system.
Capital Tonight discussed this issue last week with bill sponsor and Senate Health Committee Chairman Gustavo Rivera, who said the “Home Care Savings & Reinvestment Act” (S.7800/A.8470), which would stop the state from paying for Managed Long Term Care plans (MLTCs), could save between $1 billion and $2 billion annually.
But Eric Linzer, president and CEO of the Health Plan Association, argues that MLTC plans are actually quite valuable, and eliminating them, as Sen. Rivera wants to do, would hurt the 280,000 New Yorkers who rely on the plans.
“These plans coordinate a broad range of services, medical treatment, home care, health screenings, vaccinations, durable medical equipment to ensure that individuals are able to remain safely in their communities, and in their homes,” Linzer told Capital Tonight.
Linzer noted that 90% of MLTC plan enrollees rated their health plan as “good or excellent” and that taking away this program would disrupt the care of the state’s most at-risk individuals.
Pointing to a fiscal analysis, Linzer also questioned the savings estimates advocates have been pointing to.
“The advocates and the proponents claim that it’s going to save $17 to $20 billion over the course of the next 10 years. But when you look at their savings and the cost estimates that they put into place, much of this cherry-picks from data that misrepresents the reality of the MLTC program,” he argued.
Sen. Gustavo Rivera responded to Linzer’s comments by email.
"Private insurance plans have a direct financial interest in downplaying their costs to the healthcare system. Every year they make a profit by denying claims and cutting provider payments. Our long term care crisis and home care workforce shortage deepens while these executives siphon money that could go to direct care for patients and workers," Rivera stated.
When it was pointed out to Linzer that the MLTC services wouldn’t simply disappear if Rivera’s bill passes — that they would be replaced with a fee-for-service model — Linzer said there would be downsides.
“Those services, while they may be available, they’re not going to be coordinated in the same way,” he said.
Linzer also said that prior to the advent of MLTCs in New York, the state had a fee-for-service system that was more expensive.
“The services and supports really weren’t there,” Linzer continued. “Because of the growth in the cost of this program, the state moved to managed long term care, and in the first year, the state was able to save over $4 billion while giving these individuals a better quality of care experience.”
Rivera and state Assemblyperson Amy Paulin, the Assembly Health Committee chair, are supporting the so-called “Home Care Savings & Reinvestment Act” as an alternative to Gov. Kathy Hochul’s proposed $1.2 billion cut in Medicaid.
The state budget is due April 1.