NY1 Health Reporter Erin Billups is taking a special look at the state's Medicaid system this week, focusing on two different programs and their impact on beneficiaries.
In the first of this two-part report, she surveys the recent move away from fee-for-service payments to a managed care model—which seems to be working well.
Twenty-four hours a day, seven days a week, Anthony Trocchia needs home care.
He has spinal muscular atrophy and says the help of his four home aides is his lifeline.
"They put me in bed. They put me on the toilet. They prepare my food. They dress me. I mean, everything you’ve done since this morning when you got up until this point is everything that they help me with," Trocchia says.
Trocchia is one of six million New Yorkers who have, or are, in the process of transitioning to managed long-term care through the Medicaid program.
It's one of many recommended reforms from the State's Medicaid Redesign Team, aimed at bringing down health care costs by moving away from a fee-for-service model.
"Fee-for-service essentially is the state writes a check for each individual service, each individual prescription, each individual visit. And I think everybody in healthcare indicates that is an inefficient, ineffective way to pay," says Jim Tallon, president of the United Hospital Fund.
The most costly, high-need Medicaid beneficiaries began enrolling in managed care plans in 2012.
The organizations coordinate their health care needs, paying providers from a fixed amount from Medicaid.
The United Hospital Fund has been monitoring the progress of the transition, and its president, Jim Tallon, says, for the most part, it's working well.
"The evidence is we're moving in the right direction. For one thing, the costs of the Medicaid program aren't skyrocketing at this point and that was a threat to every Medicaid beneficiary," Tallon says.
Trocchia says he wasn't thrilled with the change at first.
"One of the concerns we had was whether there would be a gap in service because when you reside on your own, you can’t deal with a gap," says Trocchia.
He chose Independent Care System to coordinate his care and says for him it's been seamless—but that hasn't been the case for everyone.
"The bureaucracy can be very overwhelming," Trocchia
Tallon says more outreach and education is still needed.
The state also has its hands full with oversight of the managed care plans and regulatory responsibilities.
"When you make a huge change like this there are going to be growing pains," Tallon says.
In our second report on Medicaid, we'll look at how some struggle to balance spend down limits and cost of living.