MMNY opposes CMS proposed changes to the way the Basic Health Program is financed

May 7, 2019 | News

Medicaid Matters New York joins other consumer advocacy groups in opposing a proposal by the federal Centers for Medicare and Medicaid Services (CMS) to change the way the Basic Health Program is financed.

The following comments were sent to CMS on May 2, 2019:

Medicaid Matters New York, the statewide coalition representing the interests of New Yorkers served by Medicaid and other public insurance programs, opposes the proposed changes to the funding methodology for the Basic Health Program.

New York’s Essential Plan, created under the Basic Health Program authority in Section 1331 of the Affordable Care Act, provides a critical coverage option for adults with incomes up to 200% of the federal poverty level.  This is just above Medicaid income eligibility and equates to $21,330 for a family of three.  Approximately 800,000 low-income New Yorkers across the state access essential health benefits through the Essential Plan.  This includes inpatient and outpatient care, physician services, and prescription drugs.  The Essential Plan is immensely popular because it provides a high-quality, affordable coverage option to low-income people.  The Essential Plan has played a critical role in helping reduce the number of uninsured people across the state.

Medicaid Matters New York urges CMS not to finalize the proposal to incorporate a metal tier selection factor to determine the amount of federal funds for the Basic Health Program for 2019 and 2020.  CMS does not have the legal authority to make retroactive program cuts in this manner.  In addition, CMS should establish payment methodology for future program years prospectively, in adherence with required processes and timelines.

Based on CMS’ own economic impact analysis, the proposed changes to the payment methodology would result in a $300 million reduction in federal funding to the two states operating Basic Health Program – New York and Minnesota – over 2019 and 2020.  Given New York’s Essential Plan enrollment, it is estimated that 90% of the cut – an estimated $270 million – would fall on New York State.  This would deliver a devastating blow to New York’s Essential Plan, decimating this vital program for low-income New Yorkers.

We strongly urge you not to finalize this damaging proposed rule.

Download the comments here.