Joint Statement on the Adopted 2021-22 Health and Medicaid Budget

Joint Statement on the Adopted 2021-22 Health and Medicaid Budget

April 13, 2021 – Medicaid Matters New York and Health Care for All New York – the two major statewide health care consumer advocacy coalitions – applaud the State Legislature for several historic additions to the adopted state budget for 2021-22 related to funding for public schools and universities, rental and mortgage assistance, assistance to undocumented essential workers and small businesses, and taking some first steps toward restoring progressivity to the state’s tax system.  Millions of low-income New Yorkers who rely on our state’s public health insurance programs will benefit from these improvements to the Governor’s initial set of budget proposals.

However, our State leaders failed to break ground in health care, which is disappointing in light of a decade of austerity budgets and the ongoing nature of the COVID-19 public health crisis.  Medicaid Matters and HCFANY are specifically concerned about the following issues: 

  • The arbitrary Medicaid global spending cap was extended for another year.  As a consequence, Medicaid continues to be approached with an austerity mindset.  For ten years, Medicaid has suffered from unnecessary cuts, impacting access to services for low-income people, families, people with disabilities and communities.
  • Public health insurance coverage was not expanded to low-income immigrants who have had COVID-19.  Instead, those who are undocumented remain reliant solely on Emergency Medicaid for acute care and charity care programs for ongoing treatment.  As a consequence, many will likely forego seeking necessary care, thereby prolonging illness and suffering, risking death, and incurring medical bills they cannot pay.
  • The home care crisis and institutional bias remain unaddressed.  Home care workers play a vital role in serving and protecting disabled New Yorkers and seniors living independently, a role that became even more critical and evident during the pandemic.  However, New York’s failure to invest in home care has created a “worst in the nation” workforce crisis that prevents meaningful access to home care services for thousands of people and results in greater institutionalization.
  • This is the first time in decades that New York State has adopted a discriminatory maternity coverage policy.  Instead, only citizen and lawfully residing immigrant women will enroll in free (state-funded) Marketplace coverage after their Medicaid ends—continuing a system that allows for disruptions in care. 
  • No new initiatives were created to address inequities that are wide-spread throughout our state’s public health, health care, and health coverage systems, despite significant federal pandemic-related funds the state has received over the past year to address these disparities.  The pandemic has revealed them clearly, and they can no longer be ignored.

On the positive side, we thank both the Governor and Legislature for these new initiatives:

  • Eliminating all premiums in the state’s Essential Plan that provides insurance coverage to low-income people and families who are not eligible for Medicaid.  This move will enable them to keep medical, dental, and vision coverage in place without financial barriers, an important step during the ongoing pandemic.
  • Protecting the financial stability of community health centers and other safety net providers by delaying the implementation of the planned pharmacy carve-out from the state’s Medicaid Managed Care program.

We also acknowledge and appreciate restorations in funding cuts initially proposed by Governor Cuomo that made no sense given our ongoing pandemic:

  • An across-the-board Medicaid rate cut that particularly threatened safety net hospitals that serve large numbers of Medicaid and uninsured patients.
  • Elimination of Indigent Care Pool funding to public hospitals.
  • Cuts to the state’s Vital Access Provider Assistance Program that keeps certain safety net and rural hospitals financially afloat.
  • Additional cuts to Article VI public health funding to New York City.
  • Allowing insurers to impose restrictions on the ability of doctors to prescribe certain drugs to Medicaid patients (elimination of the provision known as “prescriber prevails”).
  • Another 25% cut to home care workforce recruitment and retention money that would have further harmed community-based long-term care.
  • Cuts to programs serving adult home residents.

While as a whole and on the surface it may appear that New York continues to meet the needs of those enrolled in our state’s public health insurance programs and the providers they rely on, the 2021-22 adopted budget fails to make needed investments to turn away from austerity politics, protect all immigrants, expand community-based long-term care, and promote health equity.  A lack of harm must not be confused with a budget that provides for what New Yorkers need.  We can do better, and we must.

You may download a PDF of this statement here.

Advocates “deeply disappointed” 2021-22 budget fails to repeal the Medicaid cap

April 6, 2021

Medicaid Matters New York – the statewide coalition representing the interests of people who are served by New York’s Medicaid program – is deeply disappointed the Medicaid Global Spending Cap has been extended in this year’s budget.  The spending cap, which has been in place since 2011, is an arbitrary limit that was never designed to keep pace with essential program growth.  The cap has perpetuated the notion that Medicaid growth is a problem that requires austerity, when in fact, a strong Medicaid program is a solution that allows people to have access to health care.  Investment in Medicaid is an investment in the one in three New Yorkers who rely on the program for their health and wellbeing.

The cap was not designed to be responsive to increases in the number of people covered by the program or the cost of health care services, but to impose arbitrary controls on increased spending.  Due to the economic downturn and job loss associated with the Coronavirus pandemic, over 820,000 people have newly-enrolled in Medicaid over the last twelve months.  Under the spending restrictions of the cap, the Medicaid program cannot function as a true safety net for New Yorkers, one that ensures access to care for those who are ill, provides benefits to prevent illness and maintain wellness, and upholds the right of those needing long term care to do so in the least restrictive environment.

Medicaid cuts deemed necessary to keep spending below the cap disproportionately impact:

  • People with disabilities and seniors who rely on community-based services and supports;
  • Safety-net hospitals and community-based providers, like community health centers providing primary care and community mental health centers; and
  • Historically under-resourced communities of color.

Medicaid Matters New York believes there are smarter ways to manage Medicaid spending that do not exclude or harm the very people who Medicaid is designed to serve.  New York should “Scrap the Cap,” and Medicaid Matters will continue to strive for this change on behalf of the millions of New Yorkers served by Medicaid.

PDF of this statement may be found here.

New report provides 2020 pandemic enrollment data by county

New report provides 2020 pandemic enrollment data by county

March 2021

Pandemic Enrollment Growth Highlights the Importance of Medicaid

Medicaid provides access to health care for many New Yorkers. The coronavirus pandemic, and the economic downturn resulting from the ensuing public health crisis, have highlighted the critical role that Medicaid plays in NY. 

New York has always recognized the importance of Medicaid in helping New York guarantee health coverage to all New Yorkers. At the beginning of 2020, before the first COVID-19 case appeared in NY, over 6 million New Yorkers were covered by Medicaid. Due to the economic downturn and job loss associated with the pandemic, over 700,000 new enrollees turned to Medicaid between March and November of 2020. Medicaid ensured that they did not lose access to health care when they lost their employer health insurance. That is exactly how Medicaid should respond to economic downturns.

Even before the pandemic Medicaid provided coverage to one in four New Yorkers, including low-income New Yorkers, parents and children, individuals requiring long-term care services, both in the community and in nursing facilities, those with disabilities, including physical disabilities as well as mental health disabilities, individuals with substance use disorders, and people with intellectual/developmental disabilities.

This report includes county-specific information that highlights the important role that Medicaid plays across the entire state. Each page provides three pieces of information:

  • the relative size of Medicaid within the county;
  • the growth in Medicaid since the pandemic began;
  • the contribution of the various Medicaid programs that are designed to meet the needs of specific populations.

We hope this information enhances your understanding of the importance of Medicaid in your community and for your constituents. Please reach out if you have any questions.

Download a PDF of the report here.

Data Sources:

1. NYS Medicaid Enrollment Databook, https://www.health.ny.gov/health_care/medicaid/enrollment/historical/enrollment_trends.htm

2. Medicaid Managed Care Enrollment Reports, https://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/

3. Child Health Plus Enrollment by Insurer, https://www.health.ny.gov/statistics/child_health_plus/enrollment/

Prepared by Mark King of GMHC and Denise Soffel

Medicaid consumer advocates think the Medicaid spending cap should be repealed. Here is why.

Why New York Should Repeal the Medicaid Spending Cap

Background

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. The cap was set at an arbitrary, fixed moment in time and not designed to keep pace with program growth. The 2021-22 Executive budget would extend the cap for an additional two years.

Why the cap should be repealed

  • The cap is not designed to be responsive to increases in the number of people covered by the program or the cost of health care services.
  • The cap was set arbitrarily and has not been adjusted to account for growth in the program. A certain amount of growth should be expected and predictable, for example, to accommodate an aging population that will turn to Medicaid to cover long-term services and supports, particularly in home- and community-based settings.
  • Due to the economic downturn and job loss associated with the pandemic, over 700,000 new enrollees turned to Medicaid between March and November of 2020. This demonstrates the benefit of Medicaid being responsive and flexible, assuring that people did not lose access to health care when they lost employer-based health insurance. That is exactly how Medicaid should respond to economic downturns.
  • The cap provides a platform for the Executive to frame Medicaid growth as a problem that requires austerity, when in fact, a strong Medicaid program provides a system that allows people to have access to health care when they need it.
  • The statute that created the cap grants authority to the Division of the Budget to unilaterally cut the Medicaid budget mid-year to keep spending under the cap. The Legislature has no oversight over those cuts.
  • Significant sums of public funds have been distributed outside the annual budget process at the Governor’s discretion and determined to be ‘cap neutral,’ without explanation, to justify the expenditures.
  • State Medicaid spending draws a federal match; it is the State’s largest source of federal funding. By capping state spending, the global cap also effectively caps the amount of federal funding the state can receive for its Medicaid program, which is illogical during a health and financial crisis.
  • Medicaid cuts that the Executive claims essential for remaining under the cap disproportionately impact:
    • People with disabilities and seniors reliant on community-based services and supports;
    • Safety-net hospitals and community-based providers, like community health centers providing primary care and community mental health centers; and
    • Historically under-resourced communities of color.
  • It has been argued that if the cap were repealed, an alternate fiscal mechanism would be necessary to provide structure and discipline in Medicaid budgeting. No alternative is necessary. The Medicaid budget would once again be negotiated and enacted through the annual budget process set forth by the State Constitution.

2020 Enrollment Data Demonstrates Importance of Medicaid

Between March and November 2020, over 700,000 new enrollees turned to Medicaid for health coverage due to the economic downturn associated with the Coronavirus pandemic.  A new publication by Medicaid Matters demonstrates that Medicaid did what it was intended to do and served as the social safety net people needed when they lost employer-based coverage and/or their income.

The new publication includes the voice of Jacqueline Rodriguez of New York City who relies on Medicaid for her two children who have hemophilia.

The new publication is available here.

Medicaid advocates provide response to 2021-22 Executive budget

2021-22 Budget Issues

Subject to updates as we learn more about the budget and the budget process unfolds.

Medicaid Matters believes New York needs a Medicaid program that delivers quality health care and services to all who need them.  The COVID-19 pandemic has shown us the value of a robust health care system.  While not perfect and gaps remain, New York Medicaid has a long history of providing care that meets people where they are.  Now more than ever we need investment in Medicaid to deliver on that promise and ensure all New Yorkers are able to be part of building a better future for our state.

This year’s proposed budget does not include cuts that would directly impact on access to services, as we have seen in previous years.  However, the budget fails to invest in the Medicaid program in ways that would promote access to needed services and help the entire system reach greater equity.  To do that, we need bold action to enact progressive tax reform and invest new revenue in ways that help New York build on its history of providing a Medicaid program that meets people where they are, supports community-based services, protects safety-net providers, and promotes health equity.

Repeal the Medicaid global spending cap

The budget proposal includes an extension of the global cap for an additional two years.  The global cap was arbitrarily set under the guise of the need for discipline in the way we spend money on Medicaid.  It was not designed to allow the program to grow and respond to the needs of New Yorkers.  Governor Cuomo has played shell games in Medicaid, using the global cap as an excuse to maintain austerity.  We need a budget based in reality and focused on delivering care and services people need, not arbitrary numbers that turn people into dollar signs.

Promote community-based services and supports by funding workforce

Previous enacted budgets made deep cuts to Managed Long Term Care (MLTC) in ways that will restrict access to services.  This year’s budget do not propose any similar cuts.  However, it makes no investment in community-based long term services and supports.  In fact, it makes additional cuts to home care workforce recruitment and retention funding at a time when more home care aides and attendants are needed than ever before.  The budget must promote community-based services by adequately the home care workforce to provide for people’s needs.

Protect adult home residents

Adult homes are congregate facilities for people with mental health issues, many of whom also have a variety of physical health needs.  Adult home residents rely on outside advocacy, as well as funding that meets their everyday needs outside of what the facilities provide.  The Governor’s budget zeroes out funding for the Adult Home Advocacy Project, which supports four independent advocacy organizations who represent adult home residents.  The budget also cuts Enhancing Quality of Adult Living (EQUAL) funding, which is grant funding to improve quality of life for adult home residents.  This funding must be restored.

Expand coverage for immigrants

The proposed budget does nothing to advance access to coverage for immigrants who are currently ineligible.  Medicaid Matters supports the Coverage4All campaign, calling for access to affordable health coverage for all New Yorkers, regardless of immigration status.  Short of that, this year’s budget should include $13 million to provide temporary Essential Plan coverage for people with incomes up to 200% of the federal poverty level who have had COVID-19 and are excluded from existing coverage programs because of their immigration status.

Protect safety-net providers

The proposed budget includes hospital cuts that would severely impact safety-net facilities.  These are hospitals that serve a large number of people covered by Medicaid and people who are uninsured.  To protect these hospitals, the enacted budget must:

  • Reject the proposal to eliminate the state share of the Indigent Care Pool fund (which assumes the local share would kick in to cover the cost); and
  • Add language to exclude hospitals that meet the statutory definition of “enhanced safety net” facilities from the 1% across-the-board reimbursement cut.

The moving of the Medicaid pharmacy benefit from managed care to fee-for-service (referred to as a managed care “carve-out” and enacted in the 2020-21 budget) eliminated the ability of safety-net providers to take advantage of the federal 340B prescription drug savings program.  This is a significant loss of funding to community health centers and other safety-net providers.  This year’s proposed budget provides $102 million to back-fill this funding, which is far from the total loss.  The budget must include a delay in the pharmacy carve-out for providers that rely on 340B funding.

Strengthen the Essential Plan

We applaud the Governor’s proposal to eliminate premiums for people enrolled in “EP1,” Essential Plan coverage for people with income 150-200% of the federal poverty level.  This will encourage enrollment for an estimated 100,000 people who are eligible, but for whom the $20 monthly premium was a barrier to enrollment.

Fully fund consumer assistance

The Community Health Advocates program (CHA) and Community Health Access to Addiction and Mental Healthcare Project (CHAMP) provide post-enrollment assistance statewide.  The budget fully funds CHAMP and maintains level funding for CHA.  Legislative adds would provide the total CHA funding at $3.9 million.

Restore prescriber prevails

The budget once again proposes to eliminate “prescriber prevails.”  This requirement dictates that the prescriber of a medication has the final word in any disputes over the filling of a prescription.  Medicaid Matters opposes this change and urges a restoration.

A PDF of our budget issues can be found here.