December 2, 2015•Alerts
“Here’s why Pa. shouldn’t tinker with an important healthcare program…”
Pennsylvania is proposing Managed Long-Term Services and Supports (MLTSS). This is also known as Community HealthChoices. In this new system, managed care companies (health insurance companies) would manage Office of Long-Term Living home and community-based waiver services, physical health care, and nursing facility care. Click here for background information.
A recent Op-Ed on this important issue is below. The Op-Ed can also be found by clicking here.
Disability Rights Network of Pennsylvania
Offices in Harrisburg, Philadelphia, and Pittsburgh
“Here’s why Pa. shouldn’t tinker with an important healthcare program for seniors: Another View”
By PennLive Op-Ed, The Patriot-News
December 01, 2015 at 1:00 PM, updated December 01, 2015 at 1:02 PM
For many low-income seniors and adults with disabilities in our state, access to home and community-based long-term care may soon be in jeopardy. By Jennifer Kye, Laval Miller-Wilson, Diane Menio, Peri Jude Radecic and Antoinette Kraus
Pennsylvania is planning to make private insurance companies the gatekeepers for these services, shifting the state’s Medicaid-funded long-term services and supports system to a managed care model.
Unfortunately, safeguards for consumers are not assured.
Under this model, the state would pay private insurance companies to cover and manage home and community-based services for an estimated 450,000 low-income seniors and adults with disabilities.
These individuals are currently served by the state’s Office of Long Term Living and a network of community-based providers, such as the Centers for Independent Living and local Area Agencies on Aging.
Pennsylvania’s hope for its new program, called Community HealthChoices, is to create a system with better care coordination so that consumers can live healthy, safe, and independent lives in their communities.
Every day, the state’s more than 700 nursing homes provide high-quality, compassionate care to 81,000 frail elderly and disabled residents who need around-the-clock support for clinically complex medical conditions.
As advocates for seniors and people with disabilities, we appreciate this vision but are deeply concerned about the state’s plan to turn long-term care over to private insurance companies, as well as the rapid pace at which it seeks to implement this complex new program.
We fear that the program’s goals will never be realized if the state proceeds too quickly, and that the new system could harm the people it’s meant to help.
The state only released the basic framework of its plan in September, but it has already announced it will sign contracts with insurance companies early next year.
This compressed planning period leaves little time for the state to think through complicated decisions about program design, much less get meaningful input from those who would be affected.
The current system – built over many years with experienced community-based providers – should not be dismantled so swiftly.
Managed long-term care presents a massive change that poses significant risks for vulnerable seniors and people with disabilities.
One grave concern is that service disruptions are highly likely.
Another concern is that private insurance plans, which have traditionally dealt with acute medical services, have limited experience in coordinating care for individuals with complex, long-term care needs.
These consumers require an array of supports and services, many of which are non-medical in nature but are critical to allowing people with disabilities to live in their own homes and communities.
It remains unclear whether private insurance companies understand the importance of such services and the needs of this population.
Furthermore, private insurance plans have their own need – the need to watch their bottom line. This means plans may deny services in an effort to lower costs and maximize profits.
Consumers in other states that have already shifted to managed long-term care have often suffered devastating disruptions and cuts to vital services.
In California, a chaotic transition led to consumers abruptly losing access to trusted providers.
In New York, insurance plans began denying services to the most frail and impaired consumers, instead opting to serve healthier (and thus less costly) individuals.
A similar crisis occurred in Tennessee, where consumers with worsening conditions found themselves actually losing care when they needed it the most.
And in Florida, older adults and persons with disabilities at risk of nursing facility placement filed a lawsuit against the state after suffering severe reductions in services due to the state’s switch to managed care.
In order to avoid a similar fate in Pennsylvania, we urge the state to press pause and re-evaluate its plan, particularly because of the ambitious scope of Community HealthChoices and the vulnerability of the population it would cover.
The state must consider other models for coordinating care besides enrolling consumers in private insurance plans, and it must implement any new program gradually by first testing the system in a limited geographic area.
Additionally, Pennsylvania must allow for enough time to actively involve the public, including seniors and people with disabilities, in the decision-making surrounding the mechanics of a new system.
We recommend the formation of stakeholder work groups that would contribute to key decisions on issues such as eligibility, needs assessments, service planning, quality assurance, program monitoring, and appeals for service denials.
Choices regarding these crucial issues will determine whether a new program effectively protects consumers’ interests.
While the state has recently created more opportunities for public input about Community HealthChoices, it has given no indication that it will depart from its accelerated timeline for implementing the program.
Yet if Pennsylvania persists with this current schedule, it is only inviting the unnecessary risk of harm to hundreds of thousands of vulnerable people.
The state must reconsider its approach.
With the lives of so many vulnerable Pennsylvanians at stake, if the state must proceed with managed long-term care, it should do so slowly and with caution.
Jennifer Kye is the Borchard Fellow in Law and Aging, Community Legal Services of Philadelphia; Laval Miller-Wilson is the Executive Director, Pennsylvania Health Law Project; Diane Menio is the Executive Director, Center for Advocacy for the Rights and Interests of the Elderly; Peri Jude Radecic is the Chief Executive Officer, Disability Rights Network of Pennsylvania; and Antoinette Kraus is the State Director, Pennsylvania Health Access Network.