Schimminger/Meier Push Medicaid Reform Legislation

June 5, 2006

Assemblyman Robin Schimminger and State Senator Raymond Meier announced today that they have introduced legislation (A.10177/S.6860) targeted at reforming the Medicaid program in New York State by establishing a Medicaid reform demonstration program to improve the efficiency, effectiveness and flexibility of the state’s Medicaid system.

The legislation directs the State Health Department to apply for a federal Medicaid Reform Demonstration Waiver to create a consumer-centered system that provides options for Medicaid recipients based on their particular health care needs. The demonstration program would provide quality care at the most appropriate level and is expected to result in improved access, outcomes and consumer satisfaction while at the same time limiting the growth in Medicaid spending for taxpayers. It would provide the needed flexibility to use Medicaid funds to pay for employer-sponsored health insurance when a recipient so chooses, to establish Health Services Accounts (HSAs), and to create plans for special needs populations that may benefit from services not traditionally covered by Medicaid. The bill is closely modeled after a Medicaid waiver proposed in the State of Florida which was approved by the federal government in October 2005.

“This legislation directs the Department of Health to apply for a waiver that would create greater flexibility and the most appropriate level of care to meet the needs of patients. As Chairman of the Senate’s Medicaid Reform Task Force, I have made it my mission to reform the Medicaid system in New York State with the aim of providing the most appropriate level of care while lowering the cost of the program for the taxpayers,” Meier said.

Schimminger said, “In response to concerns raised by my constituents over the mounting costs of our state’s Medicaid program, I have introduced a number of reform bills. Some of my proposals – including increases in certain co-pays and a longer ‘look-back’ period to discover transferred assets – have now been incorporated in state or federal law. This new measure is aimed at making more progress on bringing Medicaid costs under control by importing some promising strategies being pursued by other states.”

The Meier/Schimminger Medicaid Reform demonstration project includes:

  • A risk-adjusted, capitated, managed care program that is separated into three components – comprehensive care, catastrophic care, and enhanced services – that will allow for flexible HSAs. Plans would be encouraged to develop customized benefit packages targeted toward special needs populations. The Commissioner of Health may exclude specific Medicaid populations from the demonstration, and all other recipients would be given a choice of provider before being automatically assigned.
  • An opt-out provision to allow Medicaid recipients to use their Medicaid premium to purchase health care coverage through an employer-sponsored plan.
  • A counseling system to assist recipients in choosing a plan.
  • A system to monitor the provisions of health care services in the pilot program.
  • Separate grievance resolution processes for Medicaid recipients and for Medicaid providers.
  • An advisory panel to advise the Department of Health on aspects of the demonstration. The Department would comprehensively evaluate the demonstration for 24 months after the pilot projects have enrolled Medicaid recipients. Upon completion, the Health Commissioner may request statewide expansion to be approved by the Legislature.

“New York State has a long history of establishing waiver programs that have improved the lives of those receiving care and at the same time saved taxpayers money,” Schimminger said. “I hope that this initiative will help move that process forward and allow recipients to be more in control of and responsible for the services they receive by placing health care and health care coverage decisions where they belong, with the recipients.”

“We need to build upon the reforms that we have already made, such as capping the county share of the Medicaid program and the full takeover of the cost of the Family Health Plus program. I am a strong advocate of flexibility, and that’s what this legislation offers,” Meier said.

The legislators urged both houses of the Legislature to pass the legislation and the Governor to sign it so that the process of applying for a waiver of federal Medicaid rules can begin.