State of New York (Partnership Plan) - New York, NY

The Pacific Health Policy Group (PHPG) was retained by New York State to assist in a statewide reform of its Medicaid and "Home Relief" (state- and county-funded) indigent care programs. The ojective was to convert the existing programs, covering over two million recipients, to a managed care model.  

New York faced significant challenges in accomplishing its objective, including finding a way to accommodate the very different needs of the rural upstate counties and New York City; the diversity within the indigent populations, including a significant immigrant segment; large numbers of recipients with special needs, such as persons with HIV and persons with serious mental illness; the divergent and often competing interests of advocacy groups, private providers, and public/safety net providers (including numerous teaching hospitals); and perhaps most significantly, accomplishing reform within the most expensive Medicaid program in the nation.

To overcome these multiple challenges, we assisted New York in securing a Section 1115a waiver (The Partnership Plan) that would accommodate several different managed care models. We then designed and oversaw an initial HMO managed care procurement for the TANF and Home Relief populations. This managed care procurement was at the time, and remains today, the largest ever conducted for a Medicaid program, with over 50 HMOs competing for contracts in New York City and 40+ upstate counties.