HCFANY Budget Update: What Consumers Won and What Consumers Lost

HCFANY worked hard this year on a series of important priorities during this budget session. Governor Cuomo’s statement on the final enacted budget can be found here. Here is a quick summary of how consumers fared: Full funding for Community Health Advocates (CHA) HCFANY Recommendation: Provide $4.75 million in funding for CHA to help people obtain, use, and keep their health insurance coverage. Provide an additional $2 million for the Small Business Assistance Program (SBAP) to increase CHA’s capacity to serve the specialized needs of small businesses. Result: The final budget included $3.9 million for CHA – $2.5 million from the Executive and $1.4 million from the Assembly. The total funding is an increase of $400,000 from the past year. Funding for SBAP was not included in the final budget. Estate Recovery and Child Health Plus HCFANY Recommendation: HCFANY opposed allowing the Department of Health to contract with entities in pursuit of estate recovery for services provided in the Child Health Plus program. Result: This provision was not included in the enacted budget. Expansion of Child Health Plus (CHP) to Age 29 HCFANY Recommendation: Increase the age limit for CHP from 19 to 29 to create an affordable coverage option for young adults who are not eligible for subsidized health insurance because of their immigration status. Result: This measure was not included in the enacted budget. Expansion of the Essential Plan to all New Yorkers regardless of immigration status HCFANY Recommendation: Expand the Essential Plan using State-only funds to all New Yorkers up to 200 percent of the Federal Poverty Level regardless of immigration status, with particular urgency for immigrant New Yorkers who will be losing Temporary Protected Status and thus their current health insurance eligibility. Result: This measure was not included in the enacted budget. Enhanced Reimbursement for Safety Net Hospitals HCFANY Recommendation: Provide an enhanced reimbursement rate for hospitals that: (1) have at least 50 percent Medicaid or uninsured patients; (2) have at least 40 percent of inpatient discharges covered by Medicaid; (3) have no more than 25 percent of patients commercially insured; and (4) are facilities that are part of the state’s five public health systems or federally designated as critical access or sole community hospitals. Result: The final budget includes $30 million for safety net hospitals that meet the criteria above for fiscal year 2019. Indigent Care Pool for New York’s Hospitals HCFANY Recommendation: The Legislature should allow the indigent care pool (ICP) “transition collar” to sunset, and the ICP program should ensure that the ICP funding methodology is re-calibrated so that it more equitably support true safety net hospitals that are providing meaningful amounts of financial assistance to needy patients. It been extended for three years at a time in 2012 and 2015, respectively. Result: The final budget includes an additional one year of transition, instead of three, and proposes to convene a workgroup to group of consumer advocates and hospital representatives to review New York State’s distribution of disproportionate share hospital (DSH) fund and the distribution of funds through the ICP. Medicaid Beneficiary Protections HCFANY Recommendation: HCFANY opposed the following threats to Medicaid beneficiaries: (1) increase in copayments for preferred, non-preferred, and over-the-counter drugs; (2) elimination of spousal/parental refusal and reduction of resources that spouses and parents of people in managed long-term care or nursing homes can keep; and (3) repeal of “prescriber prevails.” Result: (1) There were no increases in cost-sharing for prescription or over the counter drugs in Medicaid. (2) there were no changes to spousal refusal; and (3) there were no changes to “prescriber prevails.” Managed Long Term Care (MLTC) HCFANY Recommendation: HCFANY opposed the following threats to consumers who need long term care services: (1) requirement that consumers enrolled in MLTC to remain in the same plan for a 12-month period after 30 days; (2) requirement that consumers received a Uniform Assessment System score of 9 to qualify for MLTC; and (3) carving nursing facilities out of the MLTC program. Result: (1) Consumers enrolled in MLTC will be required to remain in the same plan for a 12-month period after 90 days; (2) There were no changes to the Uniform Assessment System score necessary to qualify for MLTC; and (3) Nursing facilities will be carved out of the MLTC program for fiscal year 2019. Physical, Speech, and Occupational Therapy HCFANY Recommendation: HCFANY supported the proposal to increase the limit on physical therapy visits for Medicaid enrollees from 20 visits to 40 visits per year. HCFANY also recommended that the Legislature extend this increase to speech and occupational therapy visits as well. Result: The final budget increased the limit on physical therapy visits for Medicaid enrollees from 20 to 40 visits per year, but it did not extend this increase to speech and occupational therapy visits. Full funding for the Navigator Program HCFANY Recommendation: Provide $32 million for Navigators, who are local, in-person assistors that help consumers and small businesses shop for and enroll in health insurance through the Marketplace. Result: No action was taken.

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HCFANY Budget Update: What Consumers Won and What Consumers Lost