April 2, 2024

Last year and in the wake of our advocacy that found (among other things) the state had not been enforcing a critical contract provision required of MCOs that manage benefits on behalf of the state’s Medicaid managed care program, the NYS Council fought for enforcement of the contract provision and our advocacy has returned close to $500M (to date) to OASAS and OMH.  At the same time, we were also fighting for a bill (enacted December 2023) that requires the NYS Department of Health to post notice of any changes it intends to make to the state’s Medicaid Model Contract.   The Model Contract is a template for MMC contracting between the state and health plans, and between health plans and providers who serve New Yorkers enrolled in a special needs plan that is carved into the state’s Medicaid managed care program.  

We will always fight for transparency, enforcement and ‘real time’ information about changes that impact care recipients and their ability to access the services they need and deserve.  

Recently DOH posted a new version of the Medicaid Model Contract online, with a retroactive effective date to March 1, 2024.  They posted it with a redline of tracked changes but the only change we see relates to the contract term (Mar. 1, 2024- Feb. 28, 2029), nothing substantive.

The link is below, just click on the box for Managed Care Model Contracts.

https://www.health.ny.gov/health_care/managed_care/providers/#model_contracts

———- Forwarded message ———
From: Falcone, Adam J. 
Subject: New Medicaid Model Contract Posted

DOH posted a new version of the Medicaid Model Contract online, with a retroactive effective date to March 1, 2024.  They posted it with a redline of tracked changes but the only change I see relate to the contract term (Mar. 1, 2024- Feb. 28, 2029), nothing substantive.

The link is below, just click on the box for Managed Care Model Contracts.

https://www.health.ny.gov/health_care/managed_care/providers/#model_contracts