The letter came one day this winter, while 57-year-old Norwood resident Nilta Vazquez was still in the midst of recovering from an extensive spinal fusion surgery she’d had that fall. At the time, she was unable to walk on her own, and had a health aide helping her at home.

The letter said that Medicaid—the health insurance program for low-income and disabled New Yorkers that’s funded jointly through the state and federal governments—was requiring her to switch over to a managed care plan.

Managed care plans differ from traditional or “fee-for-service” health plans in that in the latter, a patient is allowed to visit any doctor that accepts Medicaid. In managed care, a patient instead has one primary care doctor charged with overseeing their care, and can only visit physicians within a certain, approved network of caregivers. Managed care is generally considered more cost effective, since Medicaid pays a managed care company a flat rate per person, per year, instead of many payments for each service or doctor’s visit. For several years, the state has been rolling out so-called mandatory Medicaid managed care by counties—including the Bronx—but certain groups of Medicaid patients with special health needs were traditionally exempt from making the switch.

But now, changes being made to Medicaid, commissioned by Gov. Andrew Cuomo in an attempt to rein in the state budget, will require nearly every Medicaid patient to transition into managed care—a move that some health advocates say could have adverse consequences.

“Managed care companies don’t have a good track record when it comes to treating specialized populations,” said Robert Lederer, a research and policy analyst for the Bronx Health Link, a local advocacy group. “It puts in the hands of an insurance company, that’s trying to maximize profits, this really critical decision of who gets what type of care.”

In Vazquez’s case, the change to her plan meant the loss of a home health aide that had been treating her for five years, a woman she said was the only person she felt comfortable enough with to allow herself to be bathed and intimately taken care of.

“I was being railroaded. I was so stressed out. For almost three months I was just crying,” Vazquez said. She was able to maintain her needed home care visits, she said, but was unhappy with the health aides that were sent by the agencies accepted under her new plan.

“The care that I have in place now is not reliable,” she said. “I don’t feel safe.”

The expansion of managed care is not the only change coming to Medicaid over the next several years. In an attempt to reduce state spending, Cuomo proposed cutting the Medicaid budget by $2.8 billion, and commissioned a “Medicaid Redesign Team” to come up with proposals for where that money could come from.

“This approach was not about making cuts but redesigning a program whose costs are unsustainable,” Cuomo said in a statement.

But public health advocates say certain recommendations that were adopted in the budget cut corners at the cost of services. For example, there will be limits of 20 visits per year for physical, occupational, and speech therapy for most Medicaid patients; there will be a limit on the number of mental health and substance abuse visits a patient can have; obtaining certain medications will require approval; people who receive “homemaker services” will be eligible for fewer hours of help each week.

“These changes can have a tremendous impact on the care [people] can get,” said Judy Wessler, of the Commission on the Public’s Health System.

Other changes, like a 2-percent cut to Medicaid reimbursement rates for hospitals, nursing homes and other health providers, will hit hospitals in low-income neighborhoods the hardest, Lederer says—so-called “safety net” hospitals that treat a majority of the city’s Medicaid patients and the uninsured.

“Medicaid reimbursement rates are abysmally low as it is,” he said.

Vazquez says she hopes other people are better informed of the coming changes than she was when her plan was changed.

“It’s overwhelming when you’re in a bed, and can’t walk, and you can’t get something because they’re not going to cover you,” she said.

“I wish that my body would heal miraculously, so that I could go out there and work,” she continued. “I was part of that working population at some point. I’ve worked hard in my life and I deserve better than this. People deserve better than this.”