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GuildNet Drop Out

What will come of Managed Long-Term Care Providers? That is the question many are asking today after New York State’s largest Medicaid Managed Long-Term Care Plan (MLTC), GuildNet, ceases to enroll members in Nassau, Suffolk and Westchester counties.

The company announced this decision due to what they call, “calamitous state of reimbursement,” resulting in incurring “substantial deficits” to the program.

As one may recall, MLTCs came into existence as part of the NYS Medicaid Redesign—an attempt by NYS to provide quality care under the Medicaid program while controlling costs.

MLTC plans are in place to help care for the disabled or chronically ill. They provide access to home- and community-based services needed to keep people comfortably in their homes.

CEO of GuildNet, Alan Morse, explained to the Cuomo administration his belief as to why the program is causing these deficits: “I believe this is a result of a disconnect between program mandates, such as the inappropriate use of the fair hearing process; mandating payment rates while failing to provide sufficient revenue; constant regulatory changes that add additional administrative burdens; and otherwise failing to recognize operational challenges, these changes impose.”

He also wrote that during this time, the company will be considering their options for the remainder of GuildNet. The New York State Department of Health will aid in transitioning GuildNet’s current clientele to another MLTC provider.

One year ago, EmblemHealth discontinued providing Managed Long-Term Care; Today, GuildNet is following. Assemblyman Richard Gottfried and Senator Kemp Hannon acknowledged that other plans may follow in their footsteps if the state does not pay more money to pay providers and their employees.

In the coming months, we will see if the NYS Department of Health, along with our State legislators, step up to the plate and come up with a fair solution so that seniors and younger people with disabilities will be able to live in the least restrictive environment while ensuring they receive the care they need (and are entitled to).

Vincent J. Russo
Russo Law Group, P.C.
100 Quentin Roosevelt Blvd., Suite 102
Garden City, NY 11530

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