Schimminger to Introduce Medicaid Reform Package

December 29, 2004
State Assemblyman Robin Schimminger announced today that he is introducing a package of nine bills targeted at reforming the Medicaid program in New York State. He said he is sponsoring the measures to achieve the twin goals of making Medicaid coverage more like private health insurance and containing the overall cost of the program.

"Over the past months, I have heard from hundreds of my constituents – from young working parents to retired citizens – in regard to the Medicaid program," Schimminger said. "Overwhelmingly, they have urged that the cost of the program be controlled and that the benefits of the program be brought more in line with those of private health insurance."

He continued, "It’s unfair to ask the taxpayers who pay for the Medicaid program to subsidize more generous health insurance coverage for others than they themselves have. Further, without changes, Medicaid costs will simply outstrip our ability to pay." The state must close a projected multi-billion-dollar gap between revenues and expenditures for the next fiscal year, and counties have complained they are unable to keep up with their share of program costs.

Assemblyman Schimminger’s Medicaid reform package includes:
  • allowing counties to decide which optional services and categories of eligibility included in the state program will be available to their residents,
  • eliminating or limiting certain optional services statewide,
  • imposing new co-payments and increasing existing co-payments,
  • standardizing eligibility criteria,
  • closing long-term-care eligibility loopholes,
  • raising the tax credit for long-term-care insurance,
  • increasing the number of Medicaid recipients enrolled in managed care,
  • maximizing Medicare coverage for individuals who are eligible for both Medicare and Medicaid, and
  • instituting a 90-day state residency requirement.

"Even with these changes," Schimminger said, "Medicaid would continue to provide a sound package of benefits but more in line with the coverage most other people receive. Counties and the state would realize savings, and the state could use part of its savings to assume a greater share of counties’ Medicaid costs."

"I know a single legislator alone can’t solve the Medicaid problem," Assemblyman Schimminger concluded, "but I expect to secure a number of co-sponsors, and hopefully the introduction of these bills will help move the reform process along." He noted that a number of study groups are working on proposals for reducing the cost of the Medicaid program, other related bills – including some he is co-sponsoring – have been introduced, and the adopted 2004-05 state budget included actions that are projected to save almost $400 million dollars in Medicaid costs on the state share alone, but he said that much more needs to be done.

Medicaid Reform Legislative Package Summary

  • Direct the Commissioner of Health to obtain a federal waiver to allow each county in New York to elect to cover or not cover any service or category of eligibility which is optional under Federal Medicaid law but which is presently covered under New York State’s Medicaid plan. A county which fails to file a Services and Eligibility Plan by a specified date would continue to provide all the services and categories of eligibility provided for under the state plan.
  • Set limits on services to bring coverage more in line with private health insurance. Eliminate or limit certain adult optional practitioner services statewide (e.g. dental, nursing, audiology, and psychology services).
  • Increase co-payments for both generic and brand name prescription drugs. Require a co-payment for all covered services. Require co-payments to be pre-paid at the time services are rendered.
  • Harmonize resource tests and asset levels for certain categories of eligibility similar to other states. Establish an asset allowance for those categories of eligibility where none now exists.
  • Expand the asset transfer lookback period for eligibility from three to five years and include homecare. Disallow asset shelters such as trusts and balloon annuities. Eliminate spousal refusal, cap spousal impoverishment asset allowance at current level and eliminate the current practice of shielding additional assets to bring income to the maximum monthly allowable level.
  • Increase the existing 20% long-term health care insurance tax credit to 50% of the premium paid during the tax year.
  • Establish mandatory managed care for all areas of the state including rural areas. Require the Commissioner of Health to obtain a federal waiver to enroll certain additional categories of eligibility (e.g. S.S.I.) in managed care programs.
  • Continue to maximize Medicare coverage (fully federally funded), including appealing Medicare denials before approving Medicaid and picking up payments for Medicare Part A premiums for dual eligibles.
  • Establish a 90-day state residency requirement for Medicaid eligibility.