Developing a managed care delivery system in New York State for medicaid recipients with HIV

In the state of New York, models of care known as HIV Special Needs Plans ( HIV SNPs) are being developed to meet the unique health and medical needs o f Medicaid recipients with HIV. Establishing managed care plans for the 80, 000 to 100,000 HIV-infected Medicaid recipients residing in the state has r equired considerable effort, including distributing planning grants to soli cit information and recommendations regarding program and fiscal policy; co nvening a workgroup to facilitate discussions between the state and the pro vider and consumer communities; conducting a longitudinal survey to assess the impact of managed care on persons with HIV; and developing a longitudin al, person-based, encounter-level database representing the clinical and se rvice utilization histories of more than 100,000 patients for state fiscal years 1990 to 1996. The key fiscal issues identified and discussed were cap itation rates, initial capitalization levels, and risk-adjustment mechanism s. Other pertinent issues included the importance of a benefits package sup porting a comprehensive, integrated continuum of state-of-the-art services; marketing and enrollment; attention to provider and consumer training and education needs; and interdependence of financial reimbursement and benefit s packages. From our experience in New York State, we conclude that a succe ssful model of Medicaid managed care for persons with HIV should build on t he existing infrastructure of services, using a collaborative process among government agencies, healthcare providers, and HIV/AIDS consumer communiti es. A future challenge lies in the implementation of the HIV SNP model and evaluation if its soundness and ability to ensure quality healthcare servic es.