NYS legislators approved the 2015-2016 State Enacted Budget in the wee hours of April Fool’s Day last week (no joke). As always, HCFANY groups had worked hard to promote strong health insurance provisions. Here’s where things landed when it comes to key consumer health care priorities:
- Consumer Assistance Funding: The final budget contains $3 million in State funds for Community Health Advocates (CHA), up from the $2.5 million in the Governor’s proposed budget, thanks in large part to tireless advocacy on the part of HCFANY groups and allies. State support for CHA is a huge win for consumers, who will have continued and expanded access to post-enrollment assistance with their health insurance coverage.
- NY State of Health Marketplace: The budget also includes State funding for the NY State of Health Marketplace. NY State of Health will continue offering quality, affordable health insurance – good news for the more than 2 million who have already enrolled and many more who will enroll.
- Basic Health Program (BHP): The budget includes a small amount of funding for the BHP, necessary to administer the largely federally funded program. It also gives the Department of Health (DOH) authority to set rates, and requires reports, including an actuarial report and annual report, and a plan from DOH in case of any changes in eligibility rules or federal match funding. Starting in 2016, the BHP will offer more affordable coverage to working New Yorkers earning up to 200% of the Federal Poverty Level.
- Indigent care: As proposed in the Governor’s budget, hospitals will get an additional three-year period to comply with the new payment methodology for hospital financial assistance funding (funds hospitals get to cover uncompensated care for uninsured and underinsured patients). This means that hospitals will still get funding even if they aren’t meeting the new criteria to make sure they are truly serving vulnerable patients. HCFANY opposed this extension. Advocates will need to continue monitoring New York’s indigent care payment system and fighting to keep those hospitals receiving indigent care funds accountable to their patients.
- Physician Profile Website: The budget keeps the Physician Profile Website and requires the DOH to report on how it could be expanded. Since 2000, this website has helped consumers decide if a particular physician is safe to use by providing details on board certifications, medical malpractice settlements, and other critical information. The Executive Budget had proposed eliminating funding for the website.
- Payment and Delivery System Reform: The budget requires Performing Provider Systems (PPS) under the Delivery System Reform Incentive Payment (DSRIP) Program to establish project advisory committees that include Medicaid members. And beginning January 1, 2016, the DOH must provide annual reports on the NY State Health Innovation Plan (NYSHIP).
- Prescriber Prevails and Spousal Refusals: The budget preserves prescriber prevails in fee-for-service Medicaid; and the “spousal/parental refusal Medicaid” for children with severe illness, low-income seniors who need Medicaid to help with Medicare out-of-pocket costs, and other vulnerable populations. The Executive Budget had proposed elimination of both (read more about these provisions here).
- Public coverage provisions for young New Yorkers: The budget includes up to $15 million, in addition to last year’s $5 million, to support voluntary foster care agencies in transitioning foster care youth from fee-for-service Medicaid to Medicaid managed care. The budget also aligns rates for ambulatory behavioral health services in Child Health Plus with Medicaid rates.
That’s the word from Albany on the State budget, but advocates have a few more months to influence New York’s legislative policy on health care – the legislative session continues into June.