2021 Priorities to Reach Greater Equity and Protect Medicaid Consumers

To reach greater equity and protect the Medicaid safety net and the people who rely on it, New York State must:

  • Keep Medicaid budgeting within the process set in the State Constitution to allow for full legislative and public discourse; if stakeholder bodies are seated to make recommendations on Medicaid, it is incumbent on the state to ensure substantial representation of people who are served by the Medicaid program;
  • Eliminate the Medicaid global spending cap in favor of adopting a Medicaid budget that realistically spends what is necessary to provide the program New Yorkers need;
  • Avoid across-the-board cuts (should cuts become necessary) as they disproportionately decimate programs, services, and community-based providers that low-income communities and communities of color rely on;
  • Streamline and simplify Medicaid eligibility and enrollment policy and procedures to ensure people entitled to coverage and current enrollees obtain and retain Medicaid coverage as easily as possible; retain simplified procedures put in place during the economic downturn caused by the COVID-19 pandemic;
  • Protect and enhance the ability of people to obtain and retain home- and community-based long-term services and supports, which provide for higher satisfaction, lower cost, and abide by the right to live in the most-integrated setting;
  • Enhance data collection and reporting to drill further down and capture the reality of what is happening in marginalized communities, and disaggregate data;
  • Execute health equity assessments on proposed budget initiatives and policy changes to demonstrate how specific proposals would impact on communities of color;
  • Ensure access to meaningful care coordination and needed services for all managed care enrollees; promote greater consumer input by enhancing existing satisfaction surveys and providing other opportunities for engagement; strengthen oversight of managed care organizations and revisit ways they should be held accountable for consumer experience, positive health outcomes, and overall well-being;
  • Instill greater transparency in all Medicaid spending to increase accountability and ensure public funds are spent as they are intended and in ways that serve low-income New Yorkers;
  • Enhance oversight of state contracts with large companies that do the work of administering the Medicaid program; impose restrictions on their ability to cut corners;
  • Invest in and ease access to programs and services that address social determinants of health, such as food insecurity, access to child care, housing, and more.

The intent of the Medicaid program is to provide coverage and access to low-income people and people with disabilities.  New York’s comprehensive and inclusive Medicaid program makes health care more affordable, enabling families and individuals to meet their health care needs and improve their quality of life.  It also provides access to long-term services and supports, promoting independence and dignity for people with disabilities and older adults. 

The Medicaid program has played a critical role as New Yorkers face the Coronavirus pandemic.  Medicaid enrollment has grown by hundreds of thousands of people, providing vital health insurance coverage when people across the state lost their jobs and struggled to make ends meet.  Medicaid has remained a lifeline to health care and other needed services as the pandemic surged to disastrous proportions in New York.  Unfortunately, the austerity agenda set forth by the administration has resulted in decisions to contain cost in areas that directly impact on access to human services and various non-Medicaid services.

The pandemic has brought back to light the structural racism and oppression that perpetuates poor health for people who, by no fault of their own, are more exposed and less protected from the virus.  This susceptibility is directly related to numerous factors, including living conditions, income inequality, and lack of access to quality care and services.  Thanks to Medicaid, however, many New Yorkers have been able to access health care at a time when they need it most. 

The COVID-19 public health crisis and associated economic downturn present us with an opportunity to do better.  Investing in Medicaid is an investment in New York’s future, and a properly funded Medicaid program is how New York State will build a better future for millions of people.  State leaders must reject the notion that budget austerity will help us reach the outcomes we seek.  Revenue options must be enacted to reach greater budget equity, asking wealthy New Yorkers to make small sacrifices to benefit the greater good.  With or without new federal relief, our state faces an unsustainable fiscal situation, and our state coffers must no longer be balanced on the backs of people who rely on Medicaid and other social service programs.

Medicaid Matters urges state policymakers to maintain New York’s unwavering commitment to the Medicaid program and thoughtfully address the budget crisis by preserving its strengths.  New York must show the nation that in challenging times, we stand by our families, children, older adults and people with disabilities.

Download our 2021 priorities here.

Response to the Governor’s proposed 2021-22 budget can be downloaded here.

2020 Policy and Budget Priorities

Download our 2020 Vision document here.

Medicaid Matters released this statement regarding the Governor’s Executive budget.

The Medicaid Matters Steering Committee put out this statement in response to the seating of a Medicaid Redesign Team.

The Medicaid Matters Coordinator, Lara Kassel, submitted testimony on January 29th at the Joint Legislative Budget Hearing on the Executive Budget on Health/Medicaid.

A flier was generated to provide “an alternate perspective” to the Legislature on Medicaid Matters coalition perspective on the Governor’s approach to Medicaid.

The Medicaid Matters Coordinator, Lara Kassel was interviewed on Capitol Pressroom on March 3, 2020.  Lara discussed Medicaid spending as Governor Cuomo’s Medicaid Redesign Team works to find savings in the health care program’s spending.

The Medicaid Redesign Team (MRT II) established by Governor Cuomo in February 2020 opened an online portal for accepting Medicaid redesign proposals from the public.  Members of Medicaid Matters submitted dozens of proposals to the MRT II.  Medicaid Matters compiled the proposals submitted by several Medicaid Matters members, including the Medicaid Matters submission on reconsideration of the Medicaid global cap.

Medicaid Matters joined with other groups to draft a Statement of Principles on Medicaid and the Medicaid Redesign Team.  The statement calls for reconsidering the global cap, rejecting the Governor’s local share proposal, extending the MRT process to be more representative and better equipped to vet proposals, and raise revenue from ultra-wealthy New Yorkers.  Over 150 organizations signed on to the statement.

Despite its own directive to do harm, on March 19th, the Medicaid Redesign Team approved a package of Medicaid cuts that will significantly diminish access to services and supports.  Advocates issued a series of snapshots of people who will be directly impacted by the cuts.

The Protect Medicaid campaign, along with over 130 other organizations, issued a statement on the MRT package.

The final budget included much of what the Medicaid Redesign Team recommended. Advocates responded with a statement.

2019 Policy and Budget Priorities

Through payment and delivery system reform and other initiatives, New York State has made tremendous strides to improve its Medicaid program, while also reigning in spending.  However, these major initiatives have not been without harm to consumers and communities across the state.  State budget projections are uncertain; there are threats at the federal level to dramatically change the Medicaid program as we know it; and a single payer health system may be on the horizon.  New York must stay committed to protecting its Medicaid program, the people it serves and the providers that serve them.

Medicaid Matters New York presents a vision for what New York can achieve in 2019 in the interest of Medicaid consumers through the following policy and budget priorities:

Deliver on the promise of “Care Management for All.” Inherent in the mandatory enrollment of the people previously exempt or excluded from managed care is the promise that care management will improve care and outcomes while restraining Medicaid spending.  The state must do a better job of monitoring the managed care industry to ensure people and their rights are protected in the push to find efficiencies to the program.  MMNY remains most concerned about how the transition to managed care has impacted or will soon impact the most vulnerable New Yorkers, including people with behavioral health needs, children transitioning to new services, and people with intellectual/developmental disabilities transitioning to a managed care model.

Guarantee home care and personal care for all who need it.  For too long, consumers and their advocates have faced tremendous barriers accessing home care and personal care through Managed Long Term Care.  In addition, the state has proposed changes to MLTC that are antithetical to the Olmstead decision and its own Olmstead plan.  The workforce shortage must be addressed to guarantee people will be able to live independently in their own homes.

Provide insurance coverage for New Yorkers who remain uninsured.  The State should allocate $542 million to create a state-funded Essential Plan for anyone up to 200% of the federal poverty level, for those individuals currently excluded because of their immigration status.  The State should also offer state-funded Medicaid coverage to immigrants who are losing their Temporary Protected Status (TPS) by enacting legislation proposed in 2018 (A10607, Solages/S7569-A, Hamilton).

Encourage CBO engagement in Value Based Payment to help address social determinants of health.  Because we know community-based organizations will be key in reaching the anticipated outcomes of delivery system and payment reform, the State has begun to implement specific requirements in VBP arrangements and has invested in regional planning efforts to encourage CBO collaboration and capacity to engage a value-based system.  These efforts must be continued and enhanced to ensure success and eventually promote health equity in communities across the state.

Protect and fund community-based providers and safety-net facilities that serve low-income, medically-underserved people in communities across the state.  Support for community-based primary care, behavioral health, substance use disorder and family planning providers ensures access to high-quality health care in the community and reduces reliance on more costly forms of care, such as hospital emergency rooms.  The State must provide community-based safety-net providers equitable access to needed capital dollars to expand and sustain their services and ensure they are adequately compensated for the care they provide to all New Yorkers, including the uninsured.

Preserve and expand consumer assistance programs to ensure they can provide a full range of assistance and advocacy.  In the face of continued changes to the Medicaid program, the state must adequately fund consumer assistance programs to assist people in understanding and upholding their rights under various public programs, including Medicaid, and to advocate for these rights in all venues.  New York State has been a leader in supporting consumer assistance for low-income people and people who rely on Medicaid for their needed services.  However, funding levels are often inadequate.  The State can address this by increasing the state share of LTC Ombudsman Program funding by $3 million, and by committing state-only dollars for fair hearing representation through ICAN or the Community Health Advocates program.

MMNY 2019 Policy & Budget Agenda (PDF download)

MMNY submitted testimony on the 2019-2020 Executive Budget on Health and Medicaid to the Joint Legislative Fiscal Committees.  The testimony is available here.