Medicaid redesign in New York: Best practices in collaborative advocacy to achieve positive outcomes in response to dramatic policy change

Medicaid redesign in New York State seeks to vastly change health care delivery systems to improve outcomes and reduce cost. High cost, high need vulnerable populations, such as the homeless, are viewed as key demographic groups in fulfilling these objectives. Redesign brings two fundamental changes to homeless health care in NY. First, all homeless Medicaid beneficiaries in NY are being placed in Medicaid managed care. Second, most homeless Medicaid beneficiaries in NY will receive new care coordination services from NY's ACA Health Homes initiative. It became imperative to diligently evaluate existing systems and orchestrate stakeholder relations as these major policy shifts occurred. Ultimately, more than 110,000 homeless New Yorkers, accounting for many chronically ill single adults, will be affected by these changes. Providers of Health Care for the Homeless (PHCH), a coalition of Health Care for the Homeless providers in NY, provided leadership and guidance to ensure all relevant parties were educated about the nature and impact of changes to Medicaid. PHCH, as lead advocate, served as the point of coalescence as implementation and enrollment strategies were developed. It served as a forum for local and state planning and development, and represented a key point of contact for federal regulators (primarily HRSA and CMS). To ensure a smooth transition, PHCH, as a coalition of community based experts, further provided the knowledge and understanding of issues unique to the administration of health care to homeless people. Presentation will outline model practices to promote sustainable and constructive policy change.