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Niagara County is fourth in the state in the percentage of Medicaid clients in managed-care programs, the Board of Health was told Thursday.

Karen Ayers, the county Medicaid managed-care coordinator, said about 52 percent of the county's roughly 20,000 Medicaid recipients are in the program, which the county began in November 1992.

The managed-care program became mandatory as of Sept. 10, and Ms. Ayers said counties are supposed to reach the goal of placing all clients in the health maintenance organization format within two years. However, she noted, there are several exceptions.

Clients eligible for both Medicare and Medicaid need not enter a managed care program. Also exempt are those with a traditional comprehensive medical insurance policy, those only requiring acute surgical care, and HIV patients.

The county has contracts with four managed-care providers, and those companies have written some misleading brochures for clients, charged board member Dr. Jerome Ulatowski.

"What we (doctors) are told to provide is different from what they're told to expect," he said, brandishing brochures which promise that each client will be assigned a physician. Ulatowski pointed out that some clients are assigned to nurse practitioners, not doctors.

Ms. Ayers pointed to a new federal mandate that large quantities of additional literature be supplied to managed care clients, and that it be at a fourth-grade reading level.

"It's almost impossible to put medical information in fourth-grade language and have it mean the same thing," Ms. Ayers said. She said one of the brochures Ulatowski complained about changed "health care provider" to "physician."

Besides that, Ms. Ayers said, "We're spending so much money on mailing and paper, and I'm not sure the clients read it. . . . Everybody wants to cover their tail."

John J. Reardon, head of the county speech, hearing, and language program, said some of the companies claim incorrectly that they offer the same level of coverage as straight Medicaid. Clients "are not getting full information," he said.

He pointed to some limitations on coverage of speech pathology, and said one company's staff "didn't even know if they cover hearing aids."

The board also heard:

A report on lead poisoning from Lana Zahn, a public health nurse who coordinates the county's lead program. She discussed case histories of five children whose lead levels were found to be elevated, primarily from ingesting paint chips.

Public Health Director David E. Wertman briefly discuss the Dec. 4 meeting the board will have with Erie County and state officials about a needle exchange program for intravenous drug users.

Robert Gillmeister, a Lockport resident, complain about an alleged lack of stop-smoking programs in the county in light of the proposed needle exchange program for "drug addicts who are lawbreakers." An ex-smoker, Gillmeister said, "Smokers are treated as second- class citizens."

Board President Mitchell R. Zavon said smoking cessation programs are not very effective. "Without any program, 22 percent of smokers can quit. With a program, the number of people who quit is 22 percent." he said.

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