MEDICAID MANAGED CARE
EDUCATION PROJECT

Are your clients confused about Medicaid health plans? Are your staff members having trouble answering clients' questions about Medicaid managed care? CSS can help!

Mandatory Enrollment

On July 15, 1997 New York State was given permission by the federal Health Care Financing Administration to require the State's 2.4 million eligible Medicaid beneficiaries to join a health plan by the year 2001.  Over the next three years, most Medicaid beneficiaries will receive notification that they have 60 days to select a health plan.  Although policy makers expect to realize great savings and improved care through Medicaid managed care, the real impact of the program is still to be determined.

The Need for Education

Many Medicaid beneficiaries are not fully informed about their  health care choices or about their rights in a managed care plan.  As we move millions of people into the managed care system, Medicaid beneficiaries are entitled to accessible and accurate information to effectively navigate this system and to advocate for their rights.

CSS offers two types of trainings to address this need

Preparing Medicaid Beneficiaries for Managed Care Choices

CSS offers workshops to help Medicaid beneficiaries make educated decisions about their health care.  These workshops are free of charge and offered to Medicaid beneficiaries in community-based organizations.  These one-hour workshops are interactive and focus on:

• the differences between regular Medicaid and Medicaid managed care
  
  
• how to choose a plan that's right for you and your family
  
  
• what to do if you have a problem with your plan
  
  
• your rights and responsibilities as a health plan member

Beneficiaries are provided with a free managed care handbook, suitable for readers of all levels, that reinforces the material covered in the workshop.  The handbook is currently available in English and Spanish  The content in the handbook was reviewed for accuracy by the New York City Office of Medicaid Managed Care, and the New York State Department of Health.

Protecting Your Clients' Rights Under Medicaid Managed Care

CSS offers a three-hour training for social service providers who work closely with Medicaid beneficiaries and want to learn how to better protect their clients' rights and to assist them in navigating within a health plan.  The training includes a manual which covers the rules, regulations and consumer protections of the current voluntary program and outlines the changes which will occur once the mandatory program is in effect.  The training sessions are held periodically with a registration fee of $25.00 per person.  The training focuses on:

• what is a Medicaid health plan
• the enrollment process
• concerns for people with special health care needs
• steps in the dispute resolution process
• clients' rights and responsibilities (including disenrollment and changing primary care providers)
• ways in which social service providers can connect with other advocates

Telephone Assistance Hotline: (212) 614-5400

CSS runs a phone line to answer questions relating to Medicaid managed care. CSS staff and project volunteers are available to provide Medicaid beneficiaries with information, to resolve problems, to file a complaint or grievance with their plan, or help with selecting a plan. CSS logs all calls made to the help line in a database to identify emerging systemic problems occurring as recipients enroll in and utilize managed care plans, and then relays this feedback to policy makers empowered to make decisions on the implementation and oversight of managed care in New York City.

Project Background

CSS began the Medicaid Managed Care Education Project in July 1995, with the concept of mobilizing trained community volunteers to lead interactive workshops on managed care in trusted community-based organizations.  Our aim was to develop and demonstrate a replicable model to provide Medicaid recipients with information and skills to be wise consumers of health care.  Since September 1996, CSS volunteers have lead over 270 workshops and trained approximately 250 social service providers.

The CSS curriculum can be seen as a model for bringing consumers into the dialogue on restructuring and refinancing the health care system.  A national dissemination of the CSS curriculum is currently in development.  Los Angeles and Philadelphia have been selected as sites to test the feasibility of reproducing the CSS consumer education and empowerment model in a different environment.  This demonstration project will provide the opportunity to test whether independent, community-based education on managed care can affect both the choices recipients make when selecting a plan, and how they use their plan once enrolled.

If you are interested in attending a CSS training session or if your organization is interested in sponsoring a workshop, please contact us at 212-614-5337.   For more information about the Medicaid/managed care project, contact Project Director Chris Molnar at Cmolnar@cssny.org. or call (212) 614-5401.

Related Websites

The Center for Health Care Strategies (www.chcs.org)
The Center for Health Care Strategies, Inc. is a non-profit, non-partisan policy and resource center affiliated with the Woodrow Wilson School of Public and International Affairs at Princeton University. The Center serves as a National Program Office for the Robert Wood Johnson Foundation.

Families USA (www.familiesusa.org)
Families USA is a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health and long-term care for all Americans.