March 17, 2021
Here’s the sign on letter we drafted and that our association colleagues signed on to today re: the Default Enrollment issue. It went out this afternoon (see below).
NYS Medicaid Director
Office of Health Insurance Programs
New York Department of Health, Empire State Plaza Corning Tower
Albany, NY 12237
Dear Ms. Frescatore:
We write today on behalf of hundreds of thousands of New Yorkers who receive mental health and/or substance use disorder care through the state’s public mental hygiene system, and the providers who serve them.
Recently we became aware of a significant insurance coverage transition impacting New Yorker’s who are enrolled in Medicaid Managed Care and are becoming eligible for Medicare either due to turning 65 or who are qualified for disability benefits. These individuals, often referred to as ‘dual eligible’ beneficiaries will soon be default enrolled by state approved health plans into the plans’ Medicare Advantage D-SNP and/or its’ Medicaid Advantage Plus plan. Apparently, the care recipient will have to take active steps to decline the default enrollment.
The vast majority of advocates who represent organizations that provide a broad range of mental health and/or substance use disorder services first became aware of the changes to come about 3 weeks ago, and only as result of our relationships with the Medicare Rights Center. Since then, we have been struggling to understand the details of the transition and its impact on the providers and the people they serve. There was no notification for advocates or for the staff who are responsible for assisting dual- eligible beneficiaries with coordination of benefits. We now know that the first group of health plans approved by the state to default enroll their insureds will begin April 1, to be followed by additional health plans in May and so on.
There is a very significant problem associated with this transition that will affect the continued viability of many mental health and substance use disorder providers. As the result of the planned change, providers will no longer be reimbursed at the APG government rate for Medicare-covered services rendered to these dual-eligible care recipients, despite the fact that the individual will concurrently remain enrolled in the Medicaid Managed Care Plan for which the APG government rate is mandated by law. We have already heard from several plans that confirm this information. This is an issue that will continue to grow with every passing month as more Medicaid beneficiaries turn 65 or become disabled. Furthermore, dual-eligible beneficiaries in Opioid Treatment Program (OTPs), who are default enrolled into a Medicare Advantage plan may be forced to choose between Medicare-covered OTP services to treat their opioid use disorder or continuing to receive core services under the associated Medicaid Advantage Plus plan.
The financial viability of the behavioral health community and health of those we serve is at significant risk.
We respectfully ask for an immediate meeting with you in order to rectify this urgent situation.
On behalf of the signatories below,
Sebrina Barrett, Executive Director, Association for Community Living
Amy Dorin, President and CEO, The Coalition for Behavioral Health
Allegra Schorr, President, Coalition of Medication-Assisted Treatment Providers and Advocates of New York State
Paige Pierce, Chief Executive Officer, Families Together in NYS
Glenn Liebman, Chief Executive Officer, Mental Health Association in New York State
Wendy Burch, Executive Director, NAMI-NYS
John Coppola, Executive Director, New York Association of Alcohol and Substance Abuse Providers
Harvey Rosenthal, New York Association of Psychiatric Rehabilitation Services
Jackie Negri, Director, New York State Care Management Coalition
Andrea Smyth, Executive Director, New York State Coalition for Children’s Behavioral Health
Lauri Cole, Executive Director, New York State Council for Community Behavioral Healthcare
Laura Mascuch, Executive Director, Supporting Housing Network of