County of Westchester (White Plains, NY)

Since 1994, the Pacific Health Policy Group (PHPG) has assisted this large urban county adjacent to New York City in the conversion of its Medicaid program to managed care. The work has included initial design and development of the program, negotiating on the County's behalf with both the New York State and federal governments on such matters as program design and financial participation, and assisting with all aspects of program implementation. According to the independent evaluation conducted for the program, the county's program has been successfully implemented, achieving significant cost savings while maintaining a high level of satisfaction among recipients, health plans, and providers.

PHPG also helped to design a special program for indigent adults with chronic substance abuse (chemical dependency) problems. PHPG also developed an automated tracking, reporting, and notification system for recepients exempt from enrolling in managed care on a mandatory basis.

Specific activities have included:

• Conducted a feasibility analysis on a variety of managed care program options

• Drafted a 1915(b) Waiver to permit mandatory enrollment of the County's AFDC population into managed care and subsequent amendments and renewal applications

• Directed the county's health plan procurements, including drafting of the RFP and design of evaluation criteria and scoring methodology

• Assisted with rate and contract negotiations

• Development of a 1915(b) Waiver program amendment to include the SSI population

• Development of a Coordinated Care Program design for adult general assistance enrollees with substance abuse dependency problems