To understand why LMC, a 501 bed, community hospital in Southwest Brooklyn, created a Medicaid Managed Care health plan, it is helpful to know what was happening with New York State Medicaid in the early 1980’s. Most Medicaid recipients in New York at that time were fee-for service. Each time the Medicaid recipient received a covered service, the provider billed the State Medicaid program.

The Medicaid recipient was able to see any provider that participated in the Medicaid program and agreed to accept Medicaid reimbursement rates.

This sounds like a good thing for Medicaid recipients. After all, it gave them freedom of choice and their providers were reimbursed for their care. However, in reality, it was difficult for people receiving Medicaid to find a provider that accepted Medicaid reimbursement. It was hard to find a private doctor who accepted Medicaid, and many Medicaid recipients received care in “Medicaid Mills,” emergency rooms, and overcrowded clinics. Because an individual did not have “a medical home,” care was often episodic and focused on acute intervention rather than primary or preventive care. Delays in medical intervention often meant the person was not treated until she was very sick and consequently her care was much more expensive. Care was fragmented and uncoordinated and no one was accountable for the cost or quality of the care received.

The cost of the Medicaid Program was skyrocketing. The fee-for service model did not allow New York State to ensure access to care, control cost, prevent fraud and abuse or guarantee quality of services. Other states, feeling a similar financial pinch were already turning to mandatory Medicaid managed care.

In 1982, with funding from a sizable Robert Wood Johnson Foundation grant, LMC applied for a full capitation contract from New York State and New York City to provide healthcare to Medicaid recipients in Southwest Brooklyn. By applying the principles of managed care, the founders of Health Plus hoped to provide cost effective, quality, coordinated medical care to the Medicaid enrollees. On April 1, 1984, LMC began to enroll Medicaid recipients in its program, Health Care Plus.

Over the next six years, Health Care Plus grew to an enrollment of 4,000 members and remained at that level.

In 1991, the State and City received approval from Health Care Finance Administration to pilot a demonstration project. Most persons receiving Aid to Families with Dependent Children public assistance who lived in ten selected zip codes in Southwest Brooklyn were required to enroll in a Medicaid managed care program in order to receive their Medicaid health benefits. This project was called the Southwest Brooklyn Mandatory Medicaid Enrollment Demonstration Project. Health Plus, which covered a significant geographic area of Southwest Brooklyn, was one of three original plans designated to participate in the project. Having had 8 years of experience in Medicaid managed care, Health Plus supported and offered  our  full knowledge in helping to design the demonstration project. As a result of the increased enrollment through participation in the demonstration project, Health Plus grew to a Medicaid enrollment of 13,978.

In 1991, Health Plus began to market the state-funded Child Health Plus (CHP) program. Then offering ambulatory care to children up to the age of 13, CHP addressed a critical need for health coverage in  our  local community.

In 1992, LMC began to explore the possibilities of working with other medical centers in Brooklyn and Staten Island to expand the Health Plus programs. After extensive consultation with several medical centers, LMC decided to apply for a PHSP (Pre-paid Health Services Plan) licensure, with LMC and Sisters of Charity in Staten Island as the principal providers of service. The PHSP license was granted in January 1995 and LMC transferred its existing contracts to Health Plus, effective February 1, 1995.

In November 1995, the New York State Department of Health (NYSDOH) sent out a Request for Proposal (RFP) to plans interested in participating, or continuing to participate, in the Medicaid Managed Care program. Applicants were required to cover each borough or county served in its entirety. Health Plus developed a network of quality medical and behavioral health providers to cover the boroughs of Brooklyn and Staten Island, and to meet the Medicaid benefit package requirements. In June 1996, Health Plus was offered a contract by the NYSDOH.In August 1996, the contract went into effect. Shortly thereafter,  we  expanded  our  service to include the rest of Brooklyn and Staten Island.

In 1998, Health Plus expanded its service area  once again,  adding  in  Queens and the following year,  the Bronx. In 2000,  we   began service in Manhattan, making  us  a citywide organization. In 2002, Health Plus began enrolling members in its newest program, Family Health Plus -- a New York State program that provides affordable healthcare to eligible, uninsured adults, ages 19-64, who are not eligible for Medicaid. In 2005, expansion into neighboring Nassau County increased  our  company’s service area further.

In 2008, Health Plus launched Health Plus Elite (HMO), a Medicare managed care plan for seniors and other Medicare-eligibles. In 2009, we expanded our Medicare Advantage program to include a Special Needs Plan for New Yorkers with both Medicare and Medicaid.

Health Plus contracts with Hospital Based Systems, primary care/multispecialty physician groups ( Medical Groups and Independent Practitioner Associations), and Independent Practitioners (community physicians) to provide care to  our  members.

Currently , Health Plus  enrolls  members into Child Health Plus, Family Health Plus ,Health Care Plus (Medicaid) and Medicare Advantage Prescription Drug and Special Needs plans in all five boroughs of New York City and Nassau County. In the future, Health Plus may decide to expand its service area or develop new business lines that further the Plan’s mission - promoting the health of culturally diverse populations through partnerships with  our  members, providers, and community-based organizations.