Medicaid Matters New York lays out the following policy and budget priorities to enhance and strengthen New York’s Medicaid program for all who need it. Download the document here.
Strengthen Medicaid managed care
New York has administered Medicaid through managed care plans since the mid-1990s. In 2011, the Department of Health was authorized to expand managed care to people and benefits previously excluded or exempt from mandatory managed care participation. Over the years, appropriate and effective State oversight of the operation of managed care plans has diminished. This has resulted in less access to needed care and services.
To protect New Yorkers enrolled in Medicaid managed care, the State must:
- Strengthen and enforce continuity of care and transition rights;
- Address capacity concerns to ensure that Medicaid enrollees have timely access to medical, mental health and dental providers;
- Ensure quality of care in long term care settings to ensure that Medicaid enrollees receive services according to their plans of care;
- Enhance transparency by posting Managed Medicaid Cost and Operating Reports (MMCOR) data and other data sets that demonstrate plan activity, like denials;
- Address systemic inequities by collecting and reporting managed care data based on race and ethnicity; and
- Revamp the Department of Health system for taking and addressing complaints.
Specific recommendations are provided in the Medicaid Matters 2023 Managed Care Agenda.
Medicaid Matters urges the State to let the authorization to move the system of services for people with intellectual/developmental disabilities (I/DD) to Medicaid managed care expire in 2023. New York has been exploring the possibility of managed care for people with I/DD for over ten years, and there has been no conclusive evidence such a move would improve the lives of people with I/DD. In fact, studies from other states have shown there are no savings associated with managed care for this group of people, and there is no evidence of improvements to access to services or quality of services.
Expand access to public health insurance programs and services
New Yorkers should have access to comprehensive insurance coverage, regardless of their circumstances. Universal health coverage would guarantee this as a right. In the meantime, we must work toward making improvements to public programs and access.
New York must work toward greater health equity by providing needed coverage for older adults, people with disabilities, immigrants, and children.
- Equity for older adults and people with disabilities
- Eliminate the asset limit for Medicaid for older people and people with disabilities.
- Expand eligibility for the Medicaid Buy-In for Working People with Disabilities (MBI-WPD) by eliminating the asset limit and age limit.
- Create a state-funded Essential Plan for all low-income New Yorkers, regardless of immigration status to immediately provide coverage to immigrants not eligible for insurance due to their immigration status (as we advocate for the federal government to approve the State’s 1332 waiver request, which could secure federal funding for this coverage extension).
- Provide continuous Medicaid eligibility for children from birth to age six.
Protect coverage and access in the Public Health Emergency wind-down
Due to COVID-19 easements, millions have kept their Medicaid without the stresses of an error prone recertification system. DOH should take the most expansive approach to unwinding these provisions. For instance, documentation requirements should be minimized, and notice and outreach efforts must be exhaustive so people do not lose coverage. In addition, the State should increase funding for navigators and assistors who will be key to making sure people do not lose their coverage.
Guarantee consumer and community priorities are included in the next 1115 Waiver
New York has applied for an amendment to its Medicaid 1115 waiver, and it is being described as a way to reach greater equity in the wake of the COVID-19 pandemic. The Department of Health has laid out an ambitious plan to spend over $13 billion over five years. It is critically important that consumer and community interests are included in the new waiver design.
The Medicaid Matters comments to the State and the Federal Centers for Medicare and Medicaid Services (CMS) detail specific recommendations on the waiver amendment application.
Ensure access to home- and community-based services
People have a right to live independently in their own homes in the community. Despite these rights, people suffer without home care and risk facility placement due to high turnover and workforce shortages. New York must strengthen the workforce that supports them and remove barriers to accessing services.
- Enact Fair Pay for Home Care.
- Invest in higher wages for direct support professionals who support people with I/DD.
- Create an independent advocacy assistance program for people with I/DD.
- Repeal restrictions to the Managed Long Term Care program enacted in 2020.
- Repeal the New York Independent Assessor to ensure access to needed home care hours.
Allocate Indigent Care Pool funds to safety-net hospitals
New York allocates $1 billion in Medicaid funds annually through the ICP. These and all other funds intended to protect safety-net hospitals must be distributed to facilities that actually provide services to people who are uninsured and people covered by Medicaid, rather than distributing it to all hospitals regardless of who they serve. Medicaid Matters believes all public funding for safety-net hospitals must be allocated on the basis of the statutory definition of “enhanced safety net hospital.”
Restore transparency to the Medicaid budget
New York’s Medicaid spending cap has been in place since 2011. It was presented as a mechanism to limit growth in Medicaid spending and instill discipline in Medicaid budgeting. It has allowed the administration to justify Medicaid cuts and drastic changes that diminish access to services. Medicaid Matters believes the cap should be replaced with intelligent budgeting which would allow the state to make necessary investments and adjustments reflective of real world needs and conditions. If the cap is kept in place, the state should be required to report on Medicaid spending on a monthly basis rather than quarterly. In addition, the Division of the Budget should publish plain language summaries to accompany their cap reports and should provide public webinars with live Q&A or other similar opportunities for transparent information sharing about the Medicaid budget.