By Perri Colley, Staff Reporter
While Mayor Rudolph Giuliani has proposed drastic cuts in social services for the city's poorest residents, health officials say Medicaid recipients should not fear losing all access to medical care.
They envision poor people doing what the middle class is doing: shifting to health maintenance organizations, which emphasize preventive care to reduce later illnesses and their costs. The projected savings of $1.2 billion will enable Medicaid to cover just as many people with less money, according to Giuliani's proposal.
"Managed care is a cost-efficient way of providing Medicaid," said Michael Melendez, health and human services director for the borough president's office.
Giuliani's request last Tuesday for an additional $350 million cut to Medicaid, on top of Governor George Pataki's proposed $600 million cut, follows a gubernatorial mandate to enroll all Medicaid recipients -- up to 460,000 in the borough -- into HMOs by March 1996.
Fifteen percent of the city's 1.8 million eligible Medicaid recipients, who receive a total of more than $1 billion a month, are already enrolled in HMOs like Bronx Health Plan, U.S. Health Care and Health First.
"With 15 percent in managed care, the city has seen significant savings," Melendez said. "So put everybody in, and you will have even better savings."
HMOs are aggressively recruiting Medicaid recipients at income maintenance offices, welfare offices and day care centers, said Melendez.
If all Medicaid recipients are not enrolled in an HMO by the deadline, the state will force them to join one. HMOs act as gatekeepers, limiting the kinds of treatment patients can receive by refusing to pay for measures they deem unnecessary.
Melendez said that in a perfect world the HMO system might work, but the clinics and doctor's offices that serve the Medicaid recipients already enrolled in HMOs are overcrowded. They won't be able to accommodate the remaining 1.5 million, many of whom now rely on public hospital emergency rooms for care.
Paloma Izquierdo-Hernandez, executive director of the Urban Health Plan clinic in Hunts Point, said she already treats 15,000 patients a year and can't handle many more.
"You can't have mandatory Medicaid managed care without having expanded primary care capacity," Hernandez said. "That's the real dilemma of the cuts."
Community clinics have been able to use a portion of Medicaid reimbursements received directly from the state to pay for capital improvements. Medicaid money will now be filtered through HMOs, whose per-patient payments are so low there's no money for construction.
Based on the old system, Hernandez drew up blueprints for a 40,000-square-foot clinic across the street from its present 16,000-square-foot site at 1070 Southern Blvd.
Hernandez, whose father opened the clinic in 1974, said she has worked for the expansion far too long to see it undermined by budget cuts. "I'll find a way of doing it," she said.
The Urban Health Plan clinic started in the managed care movement a year and a half ago, when it contracted with U.S. Health Care, which now covers 10 percent of the clinic's patients.
Jiselle Polanco, a Hunts Point resident, sat with her one-year-old son, Kevin Aponte, in the pediatrics center of the clinic, waiting for her son to get a checkup. Big Bird looked down from the painted cinder-block wall, and older children played with dolls and strollers in the hall.
Polanco said she enrolled in an HMO last year, after a representative of the program, Health First, had told her at a day care center that she would lose Medicaid if she didn't sign up.
The HMO she signed up with does not HAVE A contract with the Urban Health Plan clinic. Now, after years at her neighborhood clinic, she can't use it anymore. Her son can, because he isn't yet signed up with an HMO, and Medicaid reimburses the clinic directly.
"We would be much more prudent if we make sure we have a diversity of health plans so that we don't lose a patient like that who really wants to use us," said Rosemarie Longo, the clinic's spokeswoman.