The New York State Department of Health (DOH) has announced that while it has recommended implementation of mandatory Medicaid managed care enrollment for individuals with HIV, the Governor’s office will make the final decision. People with HIV are currently exempt from managed care enrollment but mandatory enrollment is permissible under existing State law. A recent DOH study of performance on selected HIV and HEDIS measures indicates better performance under managed care as compared to fee-for-service, prompting the recommendation. The study also showed lower hospital admission rates for those in managed care.
     
DOH has indicated that identifying individuals with HIV from claims data has proved difficult but estimates that up to 50,000 Medicaid fee-for-service enrollees could be impacted by mandatory enrollment. Individuals with HIV who meet other managed care exemption or exclusion criteria (e.g. those who are dually eligible, residing in a nursing home, participating in a long term home health care programs) would remain exempt. On September 3, DOH will meet with interested stakeholders to gather feedback on how to transition to mandatory enrollment. DOH does not believe that such a change requires Federal approval.