2013-2014 Budget Priorities
Support ombuds program for seniors and people with disabilities in managed care
MMNY urges the Legislature to approve the $3M to develop a “managed long term care ombuds program” in the Aid to Localities budget. This program will help managed care enrollees who have disabilities and chronic illnesses, including seniors, to resolve disputes with managed care entities; monitor systemic problems; and assist enrollees with grievances, Fair Hearings, and appeals.
Oppose elimination of Family Health Plus
The proposed budget eliminates the Family Health Plus program as of January 1, 2014. MMNY is pleased by the state’s commitment to protecting parents enrolled in the program by offering them financial assistance with the sharp increases in cost that they will experience buying coverage through New York’s Health Benefit Exchange (the Exchange). However, MMNY opposes elimination of the Family Health Program until all eligible parents can be provided financial assistance or enrolled in a Basic Health Program.
Support the establishment of a Basic Health Program in New York State
MMNY urges the Legislature to provide authority for New York to establish a Basic Health Program (BHP) as soon as federal guidance is available. A BHP would provide assistance to the low-wage working families that Family Health Plus was designed to help, and serve as a seamless bridge to coverage in the Exchange. Unless and until a BHP is established, MMNY opposes the elimination of Family Health Plus.
Support hospital charity care reforms
MMNY urges the Legislature to adopt essential reforms to the hospital charity care distribution methodology proposed in the budget and add language that would enhance transparency in this area. The State should incorporate language from A.2844 into the budget, which adds requirements for annual reports on the impact of the new payment allocation on safety net providers and access to care and shortens the transition period during which existing formulas will continue to be used.
Support funding for research on health disparities
The State should continue the critical work that began with the recommendations of the MRT Health Disparities Workgroup. MMNY believes that funding for health disparities efforts should not have to compete with funding for other valuable public health programs. The budget should include funding explicitly dedicated to research and analysis of health disparities.
Support changes to Medicaid eligibility associated with ACA implementation
MMNY urges the Legislature to adopt proposals in the budget that bring State law into compliance with the Affordable Care Act (ACA) and move the State toward an integrated continuum of affordable health insurance. Proposals include streamlining eligibility by eliminating numerous technical eligibility groups and replacing them with the four populations federal law categorizes as Modified Adjusted Gross Income (MAGI) groups; including online applications as a means of enrolling in public programs; ensuring 12 month continuous coverage for adults as well as children; extending spend down options to childless adults; and providing full Medicaid coverage to pregnant women with incomes up to 200% of the FPL.
Support streamlining Medicaid administration, but guard against the loss of expertise
The proposed budget includes consolidation of Medicaid managed care administration functions of OMH, OPWDD and OASAS under the Department of Health. MMNY appreciates the need for greater administrative simplicity in the operation and oversight of the Medicaid program, and the savings that can be achieved as a result of consolidation. We remain concerned, however, about maintaining the advances individual agencies have made in understanding and addressing the complex needs of different populations. The Department of Health must preserve and nurture the expertise and collaborative approach that these agencies have developed as it formulates policies and rates for these high- need populations.
Oppose the elimination of spousal and parental refusal
MMNY opposes the elimination of spousal and parental refusal. Without this option, family members are forced to choose between impoverishing themselves or placing the family member in need of services in a nursing facility in order to receive long term care services. The proposal to extend spousal impoverishment protections to those seeking services in managed long term care plans will be helpful to some couples and families facing this choice, but it is not a complete fix, as it provides no protections to those needing community Medicaid or long term care services outside of the MLTC program.
Support restoration of prescriber prevails for anti-psychotic medications
The budget proposes to repeal ‘prescriber prevails’ protections for anti-psychotic medications. In its place, the state is proposing an alternative program granting ‘gold card’ prescriber prevails status, with no accompanying prior authorization requirements, to prescribers who meet evidence-based practice standards. The state has said it will provide details of the gold card program in March. Should that proposal prove inadequate, MMNY supports a restoration of prescriber prevails for anti-psychotic medications to ensure that there is no interruption or obstacle to the medically approved treatment for people with serious mental illnesses.
Ensure that consumer protections are not eroded as mandatory managed care accelerates
The budget includes statutory changes that eliminate virtually all exclusions and exemptions that protect vulnerable populations from mandatory enrollment in managed care, giving the Department of Health the discretion to decide when mandatory enrollment for these populations is appropriate. MMNY is concerned that this authority could accelerate expansion of the mandatory program beyond the ability of the enrollment and delivery system to meet the complex needs of these beneficiaries. Currently, mandatory Managed Long Term Care is undergoing rapid expansion, often without clear guidance to plans, providers, and consumers about member due process protections and transition procedures.
MMNY strongly urges the Legislature to ensure that review or public vetting of program features is triggered when the Department of Health moves to mandate additional populations into managed care. We also urge swift passage of A.4996, which clarifies that those mandated into Managed Long Term Care are provided with the same rights as other Medicaid enrollees have to request Fair Hearings when services are terminated or reduced by plans, and receive Aid Continuing while they await the outcome of the hearing.
Medicaid Matters New York (MMNY) is a statewide coalition of over 140 organizations representing the interests of Medicaid beneficiaries, over five million New Yorkers who benefit directly from the Medicaid program. MMNY is unique in that it is the only statewide entity that focuses its advocacy efforts solely on the interests of Medicaid beneficiaries. For more information, visit www.medicaidmattersny.org or contact Maria Dibble, MMNY Chair, at firstname.lastname@example.org or (607) 724-2111.