Managed Care

Support to Individuals

Fundamental changes are occurring in how services and supports to individuals with disabilities will be funded in the future. The Office for People with Developmental Disabilities (OPWDD) and Department of Health (DOH) are moving towards Medicaid Managed Care as the mechanism for funding all supports to individuals with disabilities. Medicaid Managed Care will eventually replace the current fee for service system.

Medicaid Managed Care highlights several key features: Complete Care Coordination, Individualized Supports, and Value Based Payments. Care Coordination is the first step toward Medicaid Managed Care for the IDD population. Care Coordination will coordinate all forms of care, including acute care (primary and specialty care, hospitalization, dentistry, etc.), behavioral health care, and long-term care (such as the supports Coarc provides). Care Coordination is provided by independent Care Coordination Organizations operated by non-profit organizations formed under the Health Home Model.   Care Coordination replaced existing Medicaid Service Coordination and was implemented on 7/1/18.

Managed Care will also focus more on person-centered and individualized services. Individuals and families will have more choice in the types of services and supports that they are most interested in and which organizations they would like to receive those supports from.

Providers will be reimbursed for services based on their ability to help individuals achieve successful outcomes based on a variety of metrics that will be used to measure the quality of supports provided, as opposed to the provision of a ‘unit of service’.   Medicaid Managed Care is expected to be rolled out regionally with full implementation in upstate New York by 2022. For more information please visit the OPWDD and DOH websites at www.opwdd.ny.gov and www.health.ny.gov/health_care/medicaid/redesign/