Schimminger Introduces Medicaid Reform Package

February 28, 2005

State Assemblyman Robin Schimminger announced today that he has introduced 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.

"Just prior to the start of the 2005 legislative session, I announced that I would be introducing a package of legislation based on what I had heard from hundreds of my constituents – from young working parents to retired citizens – in regard to the Medicaid program," Schimminger said. "Overwhelmingly, they 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. That is reflected in the reform package I have introduced."

He continued, "I believe it is unfair to ask the taxpayers who pay for the Medicaid program to subsidize more generous health insurance coverage for others than they themselves may 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 difficulty in keeping 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 certain optional services,
  • imposing new co-payments and requiring prepayment at the time services are rendered,
  • 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 benefits 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."

The legislator acknowledged the Governor’s and others’ proposals for reforming the state’s Medicaid system, noting that he is co-sponsoring some of the other measures, including a cap on counties’ Medicaid expenditures. He concluded, "The most important thing is that we make reining in Medicaid costs a priority and that we commit to working together to achieve that goal. I hope that my reform initiative will help move that process forward."

Summary of Assemblyman Robin Schimminger’s

Medicaid Reform Legislative Package

  • 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 included 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. (A.5464)
  • 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). (A.5465)
  • Increase co-payments for both generic and brand name prescription drugs. Require a co-payment for all covered services, except diagnostic services. Require co-payments to be pre-paid at the time services are rendered. (A.5466)
  • 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. (A.5467)
  • Expand the asset transfer lookback period for eligibility from three to five years and include home care. 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. (A.5460)
  • Increase the existing 20% long-term health care insurance tax credit to 50% of the premium paid during the tax year. (A.5468)
  • 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. recipients) in managed care programs. (A.5461)
  • 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. (A.5462)
  • Establish a 90-day state residency requirement for Medicaid eligibility. (A.5463)