Download a PDF of the agenda here. Aqui en Español.
Our testimony on the Governor’s proposed 2025-2026 Health/Medicaid budget is here.
An overview of our 2025-2026 budget positions is here.
Medicaid consumers and Medicaid consumer advocates find themselves in a time of great uncertainty. The incoming federal administration and Congress are expected to propose drastic changes that would decimate the program as we know it. It is incumbent on New York lawmakers to protect the public insurance coverage people with low income and people with disabilities rely on to stay healthy and living independently in the face of potential threats from Washington.
While attention will need to turn to making sure we fight for Medicaid at the federal level, our commitment to keeping New York’s Medicaid program strong for all who need it is unwavering.
Expand Access to Public Health Insurance Programs and Safety-Net 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 New Yorkers with low income to provide coverage to anyone not eligible for insurance due to their immigration status;
- Providing multi-year continuous coverage in public insurance coverage programs; and
- Eliminating the asset test for people with disabilities and older adults.
New York must invest in safety-net health care that is accessible and available in communities across the state. The state budget must:
- support the public and private, urban and rural, safety net hospitals, and ensure equitable distribution of funding to address disparities in historically underserved areas; and
- invest in primary and preventive care by increasing Medicaid reimbursement for these critical services.
Reduce the Role of Managed Care in Providing Essential Services
- Eliminate Managed Long Term Care (MLTC) partial capitation. MLTC has proven to be a detriment to people with disabilities and older adults who receive services in their homes to keep them living in the community. MLTC plans routinely deny home care hours, yet they reap enormous fiscal benefit to administer the program. New York should eliminate MLTC partial capitation in favor of a new program that would provide care management without the costly, burdensome system that currently exists.
- Abandon potential move to mandatory 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. 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.
- Carve behavioral health services out of Medicaid managed care. Medicaid managed care has proven detrimental to the ability of New Yorkers to secure the mental health and substance use disorder care they need. Removing managed care plans from the equation would eliminate unnecessary barriers to care, simplify the reimbursement process, and return scarce resources to the Office of Addiction Services and Supports and the Office of Mental Health systems of care to address workforce shortages and gaps in services.
Implement Needed Reforms for Programs Provided through 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:
- 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;
- Address capacity concerns to ensure that Medicaid enrollees have timely access to medical, mental health and dental providers.
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 institutional placement due to workforce shortages. New York must strengthen the workforce that supports them and remove barriers to accessing services by:
- Rejecting the transition to a single fiscal intermediary for administration of the Consumer Directed Personal Assistance Program in favor of revamping fiscal intermediary licensure standards and requirements;
- Raising home care wages by enacting Fair Pay for Home Care;
- Investing in higher wages for direct support professionals who support 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, including young people.
Restore Transparency to the Medicaid Budget
New York’s Medicaid spending cap was presented in 2011. It has allowed the administration to justify cuts and drastic changes that diminish access to services. Having a spending cap is antithetical to the design of the program and is similar to caps we oppose when they are proposed at the federal level. 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 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.