Download our agenda here.
Find our testimony to the Assembly Ways and Means and Senate Finance Committees on the 2024-2025 Executive budget here.
Our one-pager highlighting our positions on the Governor’s proposed 2024-2025 budget is here.
Find a summary of the Governor’s adult mental health proposals for 2024 by the Urban Justice Center Mental Health Project here.
New York State will soon embark on extensive health equity reform through the approval of an amendment to the Medicaid 1115 Waiver. The initiatives proposed in the amendment are worthy, though are not enough to eliminate systemic inequities. Medicaid Matters has long brought recommendations to the table to do that, which would go a long way to eliminating inequities across our systems of care and services to people with low income and people with disabilities who are served by Medicaid and other public programs.
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, which Medicaid Matters supports, would guarantee this as a right. In the meantime, we must work toward making improvements to public programs and access.
New York must advance health equity by providing needed coverage for older adults, people with disabilities, immigrants, and children by:
- Creating a state-funded Essential Plan for all low-income New Yorkers, regardless of immigration status to provide coverage to immigrants not eligible for insurance due to their immigration status.
- Providing continuous coverage in Medicaid and Child Health Plus from birth to age six;
- Aligning the asset limit for people with disabilities and older adults with the new asset limit enacted in the expansion of the Medicaid Buy-In Program for Working People with Disabilities in 2023; eliminating the asset test thereafter.
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, particularly in Managed Long Term Care;
- Address capacity concerns to ensure that Medicaid enrollees have timely access to medical, mental health and dental providers;
- 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, ethnicity and disability, at a minimum;
- Add health equity standards to the model contracts and managed care rate setting methodologies;
- Revamp the Department of Health system for taking and addressing complaints and use individual complaints to identify systemic issues.
Abandon potential move to managed care for people with I/DD or other waiver populations
Medicaid Matters urges the State to abandon ideas to move the system of services for people with intellectual/developmental disabilities (I/DD) or people who are served through other Medicaid waiver services, such as the Nursing Home Transition and Diversion waiver, to Medicaid managed care. New York has been exploring the possibility of managed care for people with I/DD for over ten years, however, 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 or quality of services.
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 by:
- Enacting Fair Pay for Home Care;
- Investing in higher wages for direct support professionals who support people with I/DD;
- Implementing a robust, independent advocacy assistance program for people with I/DD; and
- Repealing restrictions to the Managed Long Term Care program enacted in 2020 (requirements based on needing assistance with at least three activities of daily living, and the addition of the look-back period for income eligibility for community-based long-term care).
While some improvements to community-based services have been made, the State must invest more heavily in community-based mental health care to ensure higher quality and greater access to needed services (as the State did with significant investments in hospital-based mental health care in recent years). New investments should be made to enhance quality in congregate residences operated by the Office of Mental Health, clinics, and psychiatric units, as well as to promote access to community supports and services for people with serious mental illness.
Maintain unimpeded access to pharmacy benefits.
In 2023, most Medicaid enrollees had their pharmacy benefits moved from Medicaid managed care to NYRx, the pharmacy benefit program managed directly by the State, with the goal of improving access to medications. Since the transition, some people have encountered problems receiving their medications, are not receiving any written notice, and are uncertain of what to do if their medically necessary prescription cannot be filled. While we recognize NYRx has been working to address these problems on a case-by-case basis, this should only be a stop-gap measure. We urge NYRx to develop a systemic approach for helping people who experience problems with prescriptions, including providing timely and clearly written notices of denials, so people covered by Medicaid have unimpeded access to the medications they need.
Restore transparency to the Medicaid budget New York’s Medicaid spending cap was presented in 2011 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 monthly on Medicaid spending 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.