NYC Medicaid managed care contractor gets extension despite advocate concern

Maximus, the contractor that operates the New York City Medicaid CHOICE managed care program, has been given a 24-month, $40.8 million contract extension by the state of New York, despite concerns expressed by state officials, complaints filed by the Legal Aid Society, and a request from consumer advocates that contract extensions be given one month at a time until issues are resolved.

Under the contract renewal, Maximus will continue to operate the New York Medicaid CHOICE program as it continues its rollout and will provide managed care education and enrollment services to 1.2 million Medicaid recipients in New York City. It also will handle education and enrollment services for Nassau and Suffolk counties.

Judy Wessler, policy coordinator for the Commission on the Public Health System in New York City, tells State Health Watch that advocates have been concerned about Maximus’ performance for a number of reasons, some of which have been made public.

She says her organization and others eagerly await a forthcoming Health Care Financing Administration review of the company’s work. Ms. Wessler had urged monthly contract reviews and extensions because "we have a company with major responsibilities that has a cloud hanging over its ability to do what it needs to do."

Looking for a stronger response

State Health Watch reported in November 1999 that there were some problems with the initial rollout of the CHOICE program, including enrollment materials not available in the many languages needed, exempt individuals receiving enrollment packets, and providers telling consumers they must enroll to be able to continue receiving services. At that time, state and city officials said they thought the rollout was going well, given its magnitude, while advocates painted a less optimistic picture.

Ms. Wessler told State Health Watch that government agencies needed to make a stronger response to the problem of enrollees being told they must choose a particular HMO to continue receiving mental health services.

"I think they need to make an example of an organization that’s been doing things incorrectly and hand out some punishment to send a message that this shouldn’t be happening." Now she says problems have continued and Maximus shouldn’t be receiving a contract extension.

For its part, Maximus is claiming considerable success. It says its telephone helpline is available in five languages, and its counselors can communicate in 12 languages. In the past two years, it says, it has sent more than 600,000 educational and enrollment packets to individuals with Medicaid and has held more than 400 presentations per month in the five boroughs that make up New York City. It subcontracted with more than 50 community-based organizations to help reach Medicaid consumers in their own neighborhoods and conduct educational workshops in their native language. As a result of these accomplishments, said Maximus CEO David V. Mastrian, MD, the contract extension and expansion "is a validation of the quality work Maximus provides to its clients. We are proud of the excellent work we have performed for citizens of New York. Maximus looks forward to continuing to increase the understanding by the Medicaid population of the health care options available to them, and improving their access to quality health care."

State officials say that of the 79,326 Medicaid recipients enrolled through May in areas of the city where Medicaid managed care is mandatory, 81% picked their health plan voluntarily, significantly more than the 60% contract target.

Susan Dooha, director of health policy at the Gay Men’s Health Crisis and co-chair of the New York City Task Force on Medicaid Managed Care, who had raised concerns with State Health Watch in 1999, told The New York Times that "the state and city are paying good taxpayers’ dollars for an effort that is falling far short and hurting the health care of low-income New Yorkers."

But Maximus official Daniel Walsky said the company has a grasp on what needs to be done. "We’re not in a process of total denial," he told The Times. "Any issue that comes up, whether we think it is supported or not, we will go back and train our staff."

[Contact Ms. Wessler at (212) 749-1227.]