The organization of health care delivery in New York State is at the threshold of a profound change with the introduction of mandatory Medicaid managed care health plans, which will affect two million low-income New Yorkers by the year 2000. As presently written, none of the plans are required to offer social work services.

Several hundred social workers gathered at the Sheraton Hotel on June 22 for a NYC/NYS NASW and 1199 Health and Human Services sponsored rally to kick off a major political and professional struggle. To ensure that standards for psychosocial care are included in Medicaid managed care contracts and that social work services are available to Medicaid enrollees, the New York State Department of Health must add social work services as a defined benefit in the Medicaid managed care benefit package.

This will not happen unless the profession takes action NOW!

"We need social workers now more than ever," Dennis Rivera, President of 1199, reminded the gathering. "There are 3.1 million New Yorkers without health insurance, and more and more patients are being denied access to health care. "You must become advocates for yourself, to help social workers create a social movement to give patients access to services. You can have a great influence on the way these regulations are drafted.

"70,000 [the estimated number of social workers in the State] educated, compassionate New Yorkers will have a tremendous influence on the politics of health care," he added.

A paper on social work and managed care issued by the NYC and NYS Chapters of NASW and the Association of Deans of New York State Schools of Social Work states the purpose of social work in health care and gives case examples on outcomes of social work intervention. The paper is being distributed to political leaders and health care professionals in order to make the case for the inclusion of social work services in regulations.

The purpose of social work in health care is threefold, the paper points out: First, to assist individuals, their families and significant others to function when illness, disease or disability results in changes in their physical state, mental state or social roles. Second, to prevent social and emotional problems from interfering with physical and mental health or with needed treatment. The third purpose of social work in health care is to identify gaps in community services and to work with community based agencies and institutions to expand the capacity of the community to provide adequate supports. (For copies of the paper, call the Chapter office at 212 668-0050.).

Shift in locus of care

Dr. Barbara Brenner, former President of the New York City Chapter and one of the authors of the paper, spoke about the adoption of managed care plans and the shift in locus of care from hospitals to primary care medical offices, clinics, and ambulatory surgery centers to manage health care in the least expensive setting. She noted that "...while managed care promises easier access to, better coordination and a higher quality of care for Medicaid patients and medically underserved communities, the health care system does not yet have the primary health care infrastructure to provide appropriate, cost effective care to large numbers of poor New Yorkers, many of whom are at risk for overusing, underusing and/or misusing medical care due to social, environmental and/or psychological problems....Little has been said about the growing gap or shortage of social services available to patients in primary care practices and outpatient clinics and the consequences of these shortages. A shortage of social work services for Medicaid patients will be just as critical as the shortage of primary care providers.

"Social work services are just as critical to quality assurance as immunizations and Pap smears," she added. The paper shows how social work intervention can improve health and mental health and reduce the cost of inappropriate utilization, and this is an argument that must be made to the political leaders who can influence regulations in this area, especially Governor Pataki, Senator D'Amato and Congressman Rangel, stated rally speakers. In addition to Mr. Rivera and Dr. Brenner, speakers included Dr. Mary Ann Quaranta, Dean of the Fordham University Graduate School of Social Service; Dr. Carmen Hendricks, President of the New York City Chapter; Gerald Beallor, Co-chair of the Chapter's Health Care Policy and Practice Network; Ruth Brandwein, President-elect of the New York State Chapter of NASW; and Geraldine Natwin, social worker at St. Vincent's Hospital and Medical Center.

Join the campaign

All social workers and social work students are urged to join the campaign to save social work in health care by writing to Governor Pataki, Senator D'Amato, and Congressman Rangel, and conveying the following message: Social services are needed to protect the rights of all Medicaid managed care patients. Social risk factors complicate the medical condition and treatment of large numbers of low income recipients.

Such risk factors include: child abuse, domestic violence, alcohol and drug abuse, legal problems, homelessness, loss of social functioning due to chronic medical illness, loss of a family member or care giver, need for nursing home or home care placements, developmental delays, school and learning problems, chronic depression, and severe personality disorders. In the "speeded up" environment of managed care, professional social workers are trained to address these social, emotional and environmental problems.

Social services must be required as a benefit in Medicaid managed care. Social services are needed along the entire continuum of health care. Large number of the 70,000 social workers in New York State are trained to be part of the health care team, to facilitate care and help to integrate the environmental services needed to maintain and restore health.

Honorable George Pataki
Governor of New York
Executive Chamber
Albany, NY 12224

Honorable Alfonse M. D'Amato
Member, U.S. Senate
Rm. 520, Hart Office Bldg.
Washington, DC 20510

Honorable Charles B. Rangel
Member, U.S. House of Representatives
Rm. 2354 Rayburn Office Bldg.
Washington, DC 20515