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.