More managed-long-term care plans to leave the market?

January 19, 2016

Posted by Crain’s New York

GuildNet, the state’s largest managed-long-term care insurance provider, acquired nearly 2,000 members from EmblemHealth after the insurer announced it would drop its MLTC plans on Jan. 1. Since then, GuildNet has been in talks with other carriers that may follow Emblem’s path, said Dr. Alan Morse, president and chief executive of Lighthouse Guild, the nonprofit that runs GuildNet.

These insurers have found that MLTC plans are more expensive to operate than anticipated, said Morse. Given these challenges, he predicted, “there will be some shrinkage in the market.”

MLTC plans are geared to the chronically ill or disabled, and provide access to an array of home- and community-based services. New York state enrollment in the plans, including the Fully Integrated Duals Advantage program, rose by about 17,000 members during the past year, to 162,000 in December, up from 145,000 in December 2014.

With the enrollment boost from Emblem, GuildNet now has more than 18,000 members in New York City and Nassau, Suffolk and Westchester counties.

Emblem is one of five carriers that also dropped out of the year-old FIDA program, which targets people who qualify for both Medicare and Medicaid. Morse said GuildNet will be sticking with FIDA and is optimistic about the reforms the state already has implemented.

He cautioned, however, that New York should continue to adjust reimbursement rates and to rein in excessive regulations for the MLTC programs.

“If the state can’t find a way to keep us financially viable, then the plans, as you saw with FIDA, will drop out,” he said.

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