Save the TBI & NHTD Waivers

As part of the ongoing effort to transform NYS Medicaid system into Managed Care, the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) Waivers are slated to move into the Managed Care system. Thanks to successful advocacy from this community, the date for this transition has been set for January 1, 2018. 

BIANYS and many stakeholders in the brain injury community have significant concerns about the transition of individuals with brain injury into the Managed Care System, including:

  • The UAS-NY assessment tool will be implemented to assess eligibility for people that have cognitive disabilities, even though the most recent numbers reported by the Department of Health shows that 30% of those currently receiving services under the TBI Waiver are at risk of losing their services based on their UAS-NY Assessment score
  • The services developed under the TBI Waiver and extended into the NHTD Waiver were created to meet the specific needs of these communities. Brain injury is a complex issue requiring specialized expertise and knowledge. We must ensure that these services remain available to support program participants.

As part of this process, the NYS Department of Health (DOH), must issue a transition plan for public comment, respond to those comments, then submit a transition plan to the Centers for Medicare and Medicaid Services (CMS) for final approval before they can implement the transition process. BIANYS will continue to provide information and updates on this process.

  • The transition plan released by DOH in June 2016 included some response to issues raised throughout stakeholder meetings and in response to the first transition plan (January 2016). However, there continue to be serious issues and concerns about the plan.
    • An appropriate transition plan must include the same level of protections for individuals that are currently served, as well as the same support system that they rely upon to remain independent in the community.
    • Specific issues are noted in the BIANYS transition plan response, including concerns about differences between the services as described in the plan and as currently described in the TBI Waiver manual, plans for carrying out the transition related to these changes, and protections to current participants throughout the process. The BIANYS responses are available for review: Response to June 2016 transition plan and Response to January 2016 plan.
  • To adequately address all of the issues involved in this transition, the process of involving community members, providers, professionals, and Waiver participants, must continue with open dialogue. We must ensure that the insights of all of these populations are included as the transition plan and timeline are developed.

BIANYS has called for a carve-out of these programs from the Managed Care system (see the BIANYS statement). While this is optimal, at minimum, the transition should continue to be delayed unless and until an appropriate transition plan is developed, because lives are at stake. The brain injury community must speak out to ensure that current and future eligible individuals with brain injury have access to quality brain injury services in the community.

Take Action! Join our Services, Support & Successful Outcomes campaign

Follow the steps below to make your voice heard:

1. Contact the NYS Governor’s office to tell him your experience with brain injury and that he must protect Waiver services. Call the office at 518-474-8390 or use the contact form.

2. Contact Your Assembly member and your NYS Senator by phone, email, or mail, or set up an in-person meeting with them. Tell them how brain injury has touched your life and why these services are necessary. Please let BIANYS know about your outreach.

3. Share this information with other members of the brain injury community, family members, friends, and advocates and encourage them to get involved.

 

Further Information on Medicaid Managed Care

New York State is transforming the Medicaid system to a managed care system. Managed Care directs almost all Medicaid spending in the state from fee-for-service Medicaid (under which health services providers bill directly to the state) to “care management”, under which a managed care organization is paid a capitated rate by the state and is then responsible for managing patient care and reimbursing service providers. According to the current timeline, participants of the TBI and NHTD Waiver Programs are slated to transition into Managed Care in January 2017. With a deadline currently in place, Waiver participants, their loved ones, and advocates need to educate themselves on the program and advocate for appropriate services to be provided to individuals with brain injury, who require unique types of assistance.

For information on the Medicaid Waiver Programs, download our Waiver Program Fact Sheet. For additional information on the brain injury services that need protection, download our Services Fact Sheet.

Managed care is a term that is used to describe a health insurance plan or health care system that coordinates the provision, quality and cost of care for its enrolled members. Managed Care requires that participants choose a Medicaid health plan to manage all medical services. If you do not choose a plan, the Medicaid Program will choose one for you. It is important to check that the plan covers your services, including doctors and care providers, to ensure that your services can continue. For more information on Managed Care visit New York Medicaid Choice: nymedicaidchoice.com/ or New York State Department of Health: health.ny.gov/health_care/managed_care/index.htm

Out of concern for people currently served under the TBI and NHTD Waivers and future individuals who need these services, BIANYS is advocating that these Waivers remain outside of the Managed Care system. We want to ensure that New York’s Medicaid program continues to be able to serve the special needs of individuals with brain injury, particularly via the specialized services that are provided through the Waiver program. This model of care has the potential to limit access to the level and types of specialized services that participants need to remain living independently in their homes.

To read the full position of BIANYS on halting the transition of the TBI and NHTD Waivers into Managed Care, please review the full BIANYS statement.

 

Further information on the Uniform Assessment System for New York (UAS-NY) can be found on the UAS-NY page of this site.