"NY Wants HIV/AIDS Patients to Move to HMOs"

"NY Wants HIV/AIDS Patients to Move to HMOs"
Associated Press (08.22.08):: Valerie Bauman

The director of New York's Medicaid program, Deborah Bachrach, is recommending that HIV-positive New York City residents who receive Medicaid benefits be switched from fee-for-service plans to managed care plans.

The state Department of Health has conducted studies that show that all patients, including HIV/AIDS patients, are more likely to thrive under managed care. Health department officials note that "special needs plans" for people with HIV/AIDS are available through health maintenance organizations.

According to a health department study, people with HIV enrolled in these types of plans reported fewer interruptions in their provider-patient relationships than did fee-for-service recipients. They also had fewer emergency room visits and incidents of pneumonia, and they were more apt to receive consistent antiretroviral therapy, the study found.

Results from a separate preliminary study found HIV/AIDS patients who are enrolled in regular Medicaid managed care plans in New York are screened for breast cancer and cholesterol at double the rates of those in a fee-for-service Medicaid program.

However, HIV/AIDS activists fear the switch will result in lower quality health care and could interrupt services for some. "This is being done simply to save the state money, and that's not a good argument for managed care," said Charles King, president and CEO of Housing Works.

Claudia Hutton, a health department spokesperson, disagreed. "This is not about saving money. This is about using the money we spend to purchase better quality coverage for Medicaid patients. We used to have 6,500 doctors in Medicaid managed care ready to serve the needs of HIV/AIDS patients. Now we have 13,000," she said. "Most Medicaid fee-for-service providers serving AIDS patients are joining managed care networks to continue the doctor-patient relationship."

The state Department of Health is expected to issue a final decision on the recommendation in the next few weeks.