Health Budget: Good Work, More to Do
Assembly Health Committee Chair Richard N. Gottfried
on New State Budget Adopted Friday
The health portion of the state budget includes important reforms to help control health care costs while protecting and improving the quality and accessibility of health care. Funding for services were not cut. We were even able to restore some programs and services that were cut in 2011 and improve some services. As chair of the Assembly Health Committee, I applaud the work of the Governor, the Health Department, the Assembly, and the Senate.
Governor Cuomo, the Assembly, and an extraordinarily broad group of advocacy organizations fought to include budget language that would establish a health insurance exchange in New York, which would help New Yorkers obtain more affordable health coverage. Unfortunately, the State Senate refused to discuss it. However, the budget does authorize the spending of federal grant money for that purpose. It is possible the Governor may be able to set up an exchange without further statutory authority. I will continue to fight for creating the exchange.
The budget continues the phased state takeover of local administration of Medicaid, requires chain pharmacies to provide translation services for individuals with limited English proficiency, protects continuity of care for people receiving home health care who are transitioning into Medicaid managed long-term care, and restores relief from high drug co-pay costs for seniors through the EPIC program.
A summary of the many actions in the health portion of the budget can be found on the Assembly’s budget website: http://www.assembly.state.ny.us/2012budget/
State Administration of Medicaid – Continues the transfer of administrative responsibility for the Medicaid program from localities to the state Department of Health. Administration will be streamlined and more consistent to improve access to care and services.
Local Share of Medicaid Costs – Current law limits the growth of the local share of Medicaid cost to 3% a year. The budget phases out that percentage increase so there will be a flat cap on local costs.
Roswell Park Cancer Institute – Requires Roswell Park Cancer Institute in Buffalo to submit a plan for fiscal independence by January 2014.
Medicaid Benefits – Some Medicaid benefits are restored or expanded, including: podiatry for adults with diabetes; services provided by certified lactation consultants to pregnant and postpartum women; services to promote care coordination and integration for individuals with hepatitis C; harm reduction counseling and services; and enteral formula for HIV related illnesses, and other diseases and conditions.
Early Intervention –Insurance provisions to require providers join insurance networks and an “arms-length” separation of evaluators, service coordinators, and providers were rejected. The state will set up a fiscal intermediary to do billing for EI providers. EI is excluded from a two percent across-the-board cut as well. EI providers will be certified by the state, instead of local governments.
Supportive Housing – A supportive housing grant program, which includes both brick and mortar and services, will be funded by re-investing Medicaid savings. Supportive housing significantly reduces Medicaid costs for high-need groups.
Pharmacy Translation – For individuals with limited English proficiency, taking medication can be life threatening if they can’t read the label and directions. The budget legislation requires chain and mail-order pharmacies to offer translation services to help customers understand the directions for their medications. I had sponsored similar legislation since 2010.
Mail Order Pharmacy – Some Medicaid patients are being told that their prescriptions are “specialty” drugs that must be filled through a specific mail order pharmacy, despite 2011 legislation intended to guarantee use of a local pharmacy. This “specialty” restriction will now only be allowed if there are clinical or professional grounds, approved by the Health Dept.
Promoting Primary Care Professions – To help encourage health care professionals to serve in underserved areas, a Primary Care Service Corps Loan Repayment Program for dentists, physician assistants, midwives, nurse practitioners, social workers, and therapists will be established. Doctors Across New York is an existing program to help physicians to practice in underserved areas; a workgroup will be set up to streamline the application and funding process.
Nursing Homes – When nursing home residents require hospital, therapeutic and other leaves of absence, “bed-hold” payments ensure the resident can return to that residence. We rejected budget language that could have ended those payments.
Long Term Home Health Care – Managed care plans are now mandated to offer the Consumer Directed Personal Care Program to chronically ill or physically disabled individuals. To ensure quality and continuity of care during the transition to managed long-term care, the Health Department will make regulations on continuity of care and track and report on consumer experiences.
Adult Care Facilities – To help promote improvements for residents in adult homes, the Enhancing the Quality of Adult Living (EQUAL) program will empower resident councils in adult homes to help determine how funds are used.
Planning for Medicaid Eligibility – To protect family members from poverty when a spouse or child needs to qualify for Medicaid, this budget rejects the proposal to repeal “spousal refusal.” Last year, the budget expanded the definition of an “estate” that could be subject to recovery after a Medicaid recipient dies to include assets such as jointly-held property, interests in trusts, and retained life estates. Because of the turmoil this expansion could cause for estate planning and property values, that expansion has been repealed.
Drug Cost Relief for Seniors – Last year’s budget cut back the Elderly Pharmaceutical Insurance Coverage (EPIC) program as of January 2012, limiting financial assistance to the 280,000 seniors relying on EPIC. The new budget provides funding so EPIC will again protect seniors from excessive Part D co-payment costs. Starting January 1, 2013, the EPIC co-pay program will be restored to where it was before this year.
Protecting Medically Fragile Children – Medically fragile children require specialized care from unique medical facilities. We created a workgroup to determine how Medicaid can properly pay providers for services to this vulnerable population.
Office of the Medicaid Inspector General – The Officer of the Medicaid Inspector General will be required to post decisions in administrative hearings on its website, to promote uniformity of policies and enforcement.
Biomedical Research and Training – The Empire Clinical Research Investigator Program (ECRIP) supports grants to teaching hospitals and others to advance biomedical research. New York will allow collaborating institutions and disciplines to receive grants in larger amounts.
Medicaid Prescription Drug Authorization – Medicaid managed care plans have formularies of what brands or generics of drugs they will cover. New language says that in the case of antipsychotic drugs, a physician will be able to insist on coverage for an off-formulary drug if medically necessary. I will work to expand and strengthen this concept.
Health Insurance Exchange – Governor Cuomo, the Assembly, and an extraordinarily broad group of advocacy organizations fought to include budget language that would establish a health insurance exchange in New York. The Senate refused to discuss it. An exchange will enable New Yorkers to get more affordable health coverage under the Affordable Care Act. The Governor may be reviewing whether he has existing authority to issue an executive order to create the exchange. I will continue to fight to create an exchange.
Funding for Key Programs – The budget provides additional funding for key health programs including Home Care Worker health benefits, a complete restoration of the Tobacco Control and Prevention program, infertility programs, SUNY hospitals, EISEP and CSE senior programs, family planning, school health clinics, the Community Service Program (CSP) Multi-Service Agencies (MSA) providing HIV/AIDS services, women’s health initiatives, Nurse Family Partnership, NORC and Neighborhood NORC programs, public education for pain management, Niagara Health Quality Coalition, and the Breast Cancer Network. Unfortunately, many important programs that I fought for did not get funding because of the state’s continuing difficult fiscal situation.