Medicaid Matters New York

Governor Spitzer’s first Executive Budget marks a sea change in New York health policy.    Medicaid Matters New York, a coalition of over 125 groups representing those most affected by Medicaid discussions -- Medicaid consumers -- supports Governor Spitzer’s 2007 Medicaid budget proposals.

The Spitzer budget protects Medicaid beneficiaries

• The budget does not contain any cuts to Medicaid beneficiaries, a refreshing change from recent years.  It includes no cuts in benefits.  It does not reduce eligibility levels – in fact, it proposes an expansion of eligibility for children.  And it does not propose any new co-pays. 

For too long, Medicaid reform discussions have put a bulls-eye on the backs of the very people the program aims to serve – mothers and children, adolescents, the working poor, people with disabilities, seniors, HIV positive individuals, homeless persons, and individuals with mental disabilities.  The proposed executive budget outlines a different approach, one that is long overdue.

Reform and restructuring proposals prioritize transparency, accountability, and community-based care

Medicaid Matters New York (MMNY) is encouraged by the Governor's commitment to bring transparency and accountability to this vital program which provides coverage to over four million New Yorkers.  

We are also encouraged by the recognition that New York State’s health care delivery system is not organized in a way that meets the needs of its residents.  Our care delivery system is heavily reliant on hospital-based care, a setting that is not designed to meet the primary care needs of New Yorkers.

• Hospitals are an integral part of the health care system.  They are a crucial provider of health care services, including primary and preventive care services.  Ultimately, however, primary care needs are best met in community-based sites that are accessible to New York’s diverse communities and neighborhoods.

• New York’s hospital-centric orientation has been at the expense of community-based services that are better positioned to meet the primary and preventive care needs of Medicaid beneficiaries, and of community- and home-based long-term care services. The health care delivery system in New York State is in need of fundamental restructuring. 

We recognize the risks involved in taking on this challenge.  It will be hard to maintain people’s access to needed health care services in an uninterrupted way while simultaneously revamping the delivery system and building much-needed primary care capacity. 

MMNY is particularly mindful of the important role of safety net institutions in New York’s most underserved communities.  The Governor’s budget proposes to redistribute Medicaid dollars to the hospitals and other providers that provide more care for Medicaid patients, a shift that MMNY supports.  We urge the Department of Health to ensure that all safety net providers, particularly in medically underserved urban and rural communities, have the funding necessary to continue their mission.  

We are eager to work with the administration in beginning this task, and we will be vigilant in monitoring the impacts of change on people’s access to care.

Expanded coverage, ensured eligibility, reduced bureaucratic hurdles

MMNY supports the Governor’s efforts to reduce the burden caused by lack of health insurance in New York’s communities. 

• The decision to expand eligibility requirements for the Child Health Plus program is a first step to provide more children with the health care coverage they need. 

 

• Additionally, efforts to streamline and simplify the process for eligible people to stay on Medicaid will help New York’s most vulnerable maintain their much needed health insurance coverage.  Churning through the Medicaid system because of the burdensome documentation requirements for recertification is costly and disrupts access to care.  .  The Governor’s plan to allow the State to confirm continued eligibility will not only save administrative costs, it may encourage other eligible individuals to seek and maintain the coverage they need. 

In addition to efforts to ease the onerous recertification requirements, MMNY urges the Governor to simplify the application process.  We support reducing the documentation requirements for new enrollees, as well as allowing self-attestation of income and assets. 

Community-based care options and managed care:  applause and concerns

MMNY endorses the Governor’s increased focus on home and community based care.  Channeling resources to build capacity within the health delivery system to provide services in a community-based, patient centered, and cost-effective manner is much anticipated from a health system that has remained stagnant to changing consumer demands. 

Many consumers want long-term care services that allow them to remain in their homes and part of their neighborhoods.  Providing coordinated services in the most integrated setting will not only save dollars, it allows patients to receive high quality care in a dignified manner.  One immediate way of providing access to home and community based care would be to allocate funds for a housing subsidy in the new Nursing Facility Transition and Diversion waiver.

MMNY has concerns about the use of managed care as a universal approach to the delivery of care for all Medicaid beneficiaries.  While Medicaid managed care has provided many beneficiaries with a health care home and better coordination of care, it should not be seen as a blanket solution to rising health care costs.  Studies show that managed care is more problematic for people with complex health care needs, and when access to specialty care is needed. 

We are particularly alarmed about the move to managed care for people with serious and persistent mental illness, as this may pose new navigational challenges.  We look forward to working with the state in evaluating alternative models for the organization and delivery of care to people with complex health care needs.

Cost savings and consumer protections in drug purchasing

MMNY supports a focus on pharmaceuticals as a potential arena for cost-savings.  Bulk purchasing by state Medicaid programs has been demonstrated to generate significant savings in other states.  The commitment to physician override of the preferred drug list is an important consumer protection that we are glad to see maintained. 

Medicaid Matters New York looks forward to working with his administration to improve Medicaid and strengthen the health care delivery system for all New Yorkers.

 

For more information:
Denise Soffel, Ph.D.
Coordinator, Medicaid Matters New York
c/o Community Service Society
105 East 22nd Street
New York, NY  10010
212-614-5308
dsoffel@cssny.org