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ABSTRACT
Amidst state-level budgetary pressures and growing elderly populations, many US states have adopted managed care for home-based services funded through the Medicaid program. New York State’s managed care mandate is part of a Medicaid ‘Redesign’ targeting health outcomes, cost control, and administrative efficiency, reflecting features emphasized by both governance and New Public Management frameworks, but neither adequately captures this case. Incorporating a Polanyian perspective can elucidate this market expansion and related reactions and re-regulation. Drawing from interviews with staff of service-providing agencies, this case study reveals outcomes contrary to goals: administrative complexity, containment of care, and unexpected costs.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1. While LTC insurance has been available for decades, premiums tend to be unaffordable and plans pay limited costs. A few respondents mentioned receiving reimbursement through insurance; most relied much more heavily on public payer sources.
3. This organization analyses New York Medicaid policy. Accessed 31 August 2016, http://www.medicaidinstitute.org/.
5. A public health insurance programme primarily for the elderly. Accessed 4 August 2016. https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html.
9. Managed care organizations. See https://www.medicaid.gov/medicaid/managed-care/index.html. Respondents sometimes referred to such organizations as MCOs, managed care companies, or MLTC plans.
10. After research was conducted, NY DOH detailed a plan to have 80–90 per cent of Medicaid managed care payments (in dollars) to providers shifted from fee-for-service (FFS) payments to VBP by 2020 (Houston, Heflin, and Tricia Citation2015, 1).
11. From http://data.bls.gov/oes/. Data extracted on January 22 2016.
12. Accessed 27 March 2017. https://www.ny.gov/new-york-states-minimum-wage/new-york-states-minimum-wage#new-york-state039s-minimum-wage.
13. Four respondents declined to be recorded.
14. The waiver was issued to approve New York’s Medicaid redesign plan.
15. Agencies were contending with increased training requirements that also raised costs. Reimbursement was due to increase. See http://www.leadingageny.org/providers/home-and-community-based-services/federal-1915c-waivers/traumatic-brain-injury-tbi-waiver/three-updates-to-the-nhtdtbi-waiver-programs/. Accessed 23 September 2015.
16. Quality Incentive Vital Access Provider Pool (QIVAPP). Frequently Asked Questions (FAQs). 6 August 2014 http://www.health.ny.gov/health_care/medicaid/redesign/qivapp_faqs.htm.
17. Key informant 9.
18. Dear Administrator letter, Department of Health, 23 April 2014. Subject: Quality Incentive / Vital Access Provider Pool Program.
21. Accessed 23 August 2016. http://fightfor15homecare.org/home-care-workers-fight-for-15-wins-wage-overtime-protections/.
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Elizabeth Nisbet
Elizabeth Nisbet is an Assistant Professor of Public Management at John Jay College of Criminal Justice, City University of New York. Her research focuses on how public policy sets boundaries between government and market responsibilities for delivering public services and assuring worker rights.