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Evaluation of Enrollment, Dynamics of Care and Patient Outcomes in the NYS Medicaid HIV Special Needs Plans

18 Years
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HIV Infections, Mental Health

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Trial Information

Evaluation of Enrollment, Dynamics of Care and Patient Outcomes in the NYS Medicaid HIV Special Needs Plans

This is a longitudinal study to examine access to care, perceived quality of life, member
satisfaction and patient-reported outcomes among HIV+ adult Medicaid recipients. Special
Needs Plans represent a new approach to managed care tailored to patients with complicated
medical and psychosocial problems,requiring a high level of service. These plans combine HIV
primary and specialty care, mental health services, substance use treatment, care for
dependent children and social services into a single comprehensive program that also
includes comprehensive case management and other provisions to retain patients in care.
Special Needs Plans represent an alternative to both, Medicaid Fee for Service (FFS) and to
mainstream Medicaid managed care.Seven different Special Needs Plans will be implemented,
serving in New York City and the surrounding suburbs. A separate non-profit corporation
administers each SpecialNeeds Plan. Each plan encompasses a network of hospitals, providers,
and communitybased organizations. Although all plans offer many of the same basic services,
they differ in terms of organization and coordination of care, approaches to case
management,specific program enhancements (e.g., patient education, wellness programs, or
complementary medicine) and special provisions to meet the needs of subgroups of patients
(e.g., women, substance users, young gay men, Latinos). The HIV Special Needs Plans
represent an innovation in health service delivery and financing that is being evaluated as
a national model for Medicaid service delivery by the federal government, including HRSA and
HCFA. This protocol represents a component of that evaluation,from the patients'
perspective.This study is being conducted in collaboration with the New York State
Department of Health (NYSDOH) AIDS Institute. As a component of their Quality Management and
Improvement Programs, Special Need Plans have agreed to assist with recruitment of
participants to this evaluation. We will recruit 120 patients sampled from each of the six
plans and follow these patients for initially a year with a possibility of continuing to
interview them for up to two years. We will also recruit a sample of 360 current Medicaid
fee for service patients to serve as comparison group. This sampling strategy will allow us
to examine experiences in care and outcomes for different subgroups of patients within the
plans, distinguish the affects of service differences among the plans and compare different
plan enrollees to similar patients who remain in the Medicaid FFS program. Our longitudinal
design will also permit us to examine prospective influences on comparison group patients'
decisions to switch their coverage from Medicaid FFS to Special Needs Plans.

Inclusion Criteria:

PWHA must meet the following criteria:

- Medicaid Special Needs Plans or Fee For Service as health insurance at the timeof

- Age 18 years or older

- A current resident of New York State

- Able to respond to interview questions in English or Spanish.

- Express willingness and ability to complete a series of one-hour long interviews
(interviews may be completed over two telephone sessions, if PWHAs prefer)

- Have cognitive and physical capacity to comprehend and complete the informed consent

Exclusion Criteria:

- Enrollment onto the study at an earlier site (we may encounter the same PWHA at more
than one FFS recruitment site) • Staff members from Special Needs Plans or FFS
Recruitment site determine that it is inadvisable to refer a PWHA to this study for
any reason.

Type of Study:


Study Design:

Observational Model: Case Control, Time Perspective: Prospective

Outcome Measure:

This study makes use of several new assessment approaches designed to provide a more in depth understanding of access to care, changes in care, and patient-reported outcomes.

Outcome Time Frame:


Safety Issue:


Principal Investigator

Bruce Rapkin, Ph.D.

Investigator Role:

Principal Investigator

Investigator Affiliation:

Memorial Sloan-Kettering Cancer Center


United States: Institutional Review Board

Study ID:




Start Date:

February 2003

Completion Date:

January 2009

Related Keywords:

  • HIV Infections
  • Mental Health
  • Special Need Plans
  • Fee for Services
  • Access to Care
  • Medicaid
  • HIV Infections
  • Acquired Immunodeficiency Syndrome



Memorial Slaon-Kettering Cancer CenterNew York, New York  10065