Recorded presentation

Elana Berman, MPH, Managed Care Consumer Assistance Program, Community Service Society, 105 East 22nd Street, New York, NY 10010, 212-614-5437, eberman@cssny.org and Christine Molnar, MS, Community Health Access Department, Community Service Society of New York, 105 East 22nd Street, New York, NY 10010.

The last four years have marked a momentous transition in New York City’s Medicaid program, from a fee-for service to a mandatory managed care system. To date, close to 70% of all eligible Medicaid beneficiaries in New York City are enrolled in a health plan, totaling close to 1.3 million enrollees. In an effort to inform and advocate for vulnerable Medicaid consumers’ needs, New York City Department of Health created a model ombudsprogram, the NYC Managed Care Consumer Assistance Program (NYC MCCAP). The NYC MCCAP is a public/private partnership between the Community Service Society (a non-profit advocacy organization) and the New York City Department of Health. This innovative project assists consumers in navigating their health plan and helps them to overcome barriers to accessing necessary health care services. NYC MCCAP targets its services to limited English proficiency, immigrant and other vulnerable communities through a network of over 20 trained grassroots organizations throughout New York City. The majority of NYC MCCAP consumers are non-English speaking, approximately 50% are foreign born and 75% are racial or ethnic minorities. This presentation will analyze the program’s database of almost 20,000 cases to identify trends in barriers to accessing care by racial and ethnic groups as well as demonstrate how the program model is effective at addressing those barriers. The presentation will highlight barriers that appear to be systemic and provide recommendations for improving access to care for vulnerable communities in Medicaid managed care programs nationally.

Learning Objectives:

• Identify the benefits of using a grassroots network of agencies to advocate for consumers of managed care.
• Articulate three common problems Medicaid consumers experience with managed care.
• Understand the benefits of an advocacy network that utilizes community resources to navigate managed care systems.
• Discuss the concepts of the comprehensive database used by the NYC MCCAP to promote the development of similar databases in other programs.

Keywords: Managed Care, Community Building

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Community Service Society of New York NYC MCCAP (Managed Care Consumer Assistance Program)
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation