Bronx health advocates oppose bill that seeks to eliminate managed long-term care plans

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Some Bronx organizations for home-based health care are speaking out against a bill sponsored by state Sen. Gustavo Rivera that would eliminate Managed Long-Term Care Plans (MLTCs), which streamline services for people with chronic medical conditions who need extensive care but wish to remain in their homes.

Services for everything from meal delivery to eye care to podiatry to physical therapy — in addition to clinic and hospital visits — can funnel through an MLTC, depending on one’s selected plan. Many seniors rely on such plans.

Any changes to senior health care could affect many New Yorkers and Bronxites in particular. A January 2023 report by the nonprofit Center for an Urban Future found that the statewide population of seniors is “booming,” and the Bronx’s older adult population grew 35% over the past decade — making it one of the fastest-growing counties in the state. 

Rivera, who represents the 33rd district including Fordham, Riverdale, East Tremont and Kingsbridge Heights and chairs the Senate Health Committee, called MLTC’s “high-priced middlemen” and said that eliminating them would bring about “significant savings” that could be invested back into Medicaid and used to bolster wages for healthcare workers amid a nationwide workforce shortage.

But some Bronx health organizations are pushing back on Rivera’s bill, arguing that it would actually be costly to the state and disruptive to medical care for seniors who need it most.

Broken system?

The bill would repeal the state’s MLTC program and transition patients to a fee-for-service model or “fully capitated” program such as Medicaid Advantage Plus and Program of All-Inclusive Care for the Elderly (PACE).

“Fully capitated” means a flat fee is paid to the insurance company for each patient covered, regardless of exact services. A fee-for-service model, on the other hand, pays individually for each service provided. MLTCs are partially capitated and cover only certain services. 

While Rivera argues that these partially capitated plans are costly and inefficient, advocates like Yelena Schmidt, president and CEO of Bronx-based Friends and Family Home Care Services, say the opposite. 

According to Schmidt, MLTCs are generally working well for patients and the state. The bill is “trying to break a system that works,” she said.

According to a report by a statewide group representing health care providers and health plans, New Yorkers who use MLTCs — around 300,000 people — are overwhelmingly happy with their care. 

The group, which included the New York Health Plan Association and New York State Coalition of Managed Long-Term Care Plans, cited Department of Health surveys showing that 90% of respondents rated their MLTC plan as good or excellent, and 86% said their plan was good or excellent at helping to manage their health issues.

Schmidt told the Bronx Times that the bill would lead to huge disruptions and delays in care, due largely to increased administrative burdens. 

“If you break the chain, it’s gonna create a lot of issues,” she said. 

Making insurance companies richer?

In 2011, under Gov. Andrew Cuomo, the state moved people needing long-term care (over 120 days) into MLTCs on a mandatory basis. But MLTCs were intended to develop into fully captivated plans, which never happened over time.

Rivera was not available for interview with the Bronx Times but said in an email statement that MLTCs have only made insurance companies richer.  

“New York privatized the management of long term care more than ten years ago, but that has not saved our state money or improved care delivery for New Yorkers. Instead, it has enriched private health insurance companies,” said Rivera. 

Rivera continued that in the past four years, the state “has given billions of dollars to the private insurance companies ‘managing’ home care in administrative costs and profits.”

But advocates say that this change would be bad for patients’ continuity of care — and that the bill’s estimated savings are based on flawed assumptions.

“Switching to a fee-for-service program would increase costs to taxpayers while disrupting care for the people who need it most,” said Emma DeVito, chair of the NYS Coalition of MLTC Plans, in a statement. 

While the debate over eliminating MLTCs can wander into confusing financial weeds, advocates like Schmidt want to keep the issue in perspective. As a Bronx-based organization, “We’re in the community, we understand the needs” of multigenerational families, she said.

“In the grand scheme of things, how much is a life worth?”

Reach Emily Swanson at or (646) 717-0015. For more coverage, follow us on Twitter, Facebook and Instagram @bronxtimes