Cuomo Launches Medicaid Redesign Team,Advocates Call for More Consumer Representation

Thursday, January 6, 2011

NYAPRS: Here's the first of 3 postings on yesterday's state of the state address by NYS Governor Andrew Cuomo.

Medicaid

Too Much Spending

"The State of New York spends too much money, it is that blunt and it is that simple. Our spending has far exceeded the rate of inflation. From 1994-2009, inflation was about 2.7% per year; Medicaid went up over 5% per year... We spend more money on Medicaid than any other state in the nation and we are number 21 in results."

Cuomo Address

New Secretary for Health, Medicaid and Oversight Introne

James Introne, currently president and chief executive of ArchCare, is replacing Wendy Saunders. Her title was deputy secretary for health, Medicaid and oversight, but it isn't clear whether Mr. Introne will inherit that title. Gov. Andrew Cuomo in his State of the State Address introduced Mr. Introne, who served on his transition committee, and welcomed him back to New York government. That was a reference to Mr. Introne's tenure as commissioner for the Office of Mental Retardation and Developmental Disabilities from 1980 to 1982.

Crain's Health Pulse

New Medicaid Director Jason Helgerson

In attempts to solve $41.8 billion in budget shortfalls projected over the next three years, Gov. Andrew Cuomo has recruited Jason Helgerson, a health finance professional from Wisconsin credited with helping that state tighten a bloated Medicaid system and create greater usage and more efficient programs.

Cuomo announced Helgerson will be the first-ever New York state Medicaid director. His task is to help redesign the $50 billion program and save about $2.1 billion in state funds -- or $4.2 billion, including federal matching funds, according to Dan Sisto, president of the Healthcare Association of New York State, who will serve on a "stakeholders" committee.

...Helgerson's work in Wisconsin involved getting health care interests to help him find ways to cut a targeted sum of $633 million from Wisconsin's 2009-2011 budget, or about 10 percent of the entire Medicaid budget, which is funded evenly between state and federal dollars.

D'Anna Bowman, Wisconsin state director for the AARP, said Helgerson was instrumental in creating a more efficient and effective Medicaid program through cuts that were done cooperatively rather than controversially.

"What's gone on in the last two years in terms of Medicaid is exceptional; we are considered a model," Bowman said. She said family care programs have been retooled so that there is more money for home and family care rather than sending so much to nursing homes and other long-term institutions.

She said AARP and other interested parties worked with Helgerson to remake the program. Fully 98 percent of children in Wisconsin are currently under some form of health coverage. She said if she were a New Yorker, "I would be excited."

Courtney Burke, director of the Health Policy Research Center for the Rockefeller Institute, said the Wisconsin model focused on making it easier for people to enroll while reforming reimbursement rates, but without dictating how that would be done.

Providers and constituencies working with state officials found the cuts and charted progress with an innovative "dashboard of accrued savings" so that each month the group could monitor savings for a variety of medical procedures.

"They had more than 40 different ideas on reaching the projected savings," she said. For instance, C-section reimbursement rates were modified for $214,000 in savings in the first eight months of last year.

Cuomo wants the committee and Helgerson to begin working on Friday and report back by March 1 so that the savings plan can be part of the budget for next fiscal year. "I guess the challenge to do this is (having) 52 days to transform the Medicaid program," Sisto said. "It's going to be obviously an enormous undertaking."

Albany Times Union

Medicaid Redesign Team

We need to try a different approach... The State of Wisconsin actually used an interesting model. The governor had announced across the board cuts on the Medicaid program, the industry said they couldn't live with the cuts, and what Wisconsin actually did was basically brought everyone in. It was a hybrid alternative dispute resolution meets binding arbitration process and it actually worked fairly well in Wisconsin. The industry came in, they worked with the government, they accepted the budget target and then redesigned the program to meet those targets.

Remember, this is not going to be a budget cutting or trimming exercise. We need to redesign the Medicaid program. I can also tell you this. As the Attorney General, I audited the Medicaid program for four years, even without this budget problem, the Medicaid program needs a desperate overhaul. It is dysfunctional on many levels, so this process has to be done anyway. Our suggestion is to take a crisis management approach and put together a Medicaid Redesign team.

The Medicaid Redesign team will start on January 7, it will commit to reinventing a time for the April 1st deadline, it will assume the Governor's budget target for the Medicaid cut, and the exercise will be to find alternative ways to reach that cut. If we institute a cut in the normal budget process it is basically through reducing the reimbursement rate. Let's see if we can't actually find efficiencies in the program so we actually provide a better service for less money.

The committee will include legislative, executive and the stakeholders. Dennis Rivera from SEIU, George Gresham from 1199, Mike Dowling (sp?) from LIJ, Ken Raske, Dan Sisto members of the Legislature have agreed to participate in this process. We also have Jason Helgerson who is the former Medicaid director, who did this in Wisconsin, who is responsible for designing the exercise...

Cuomo Address

Governor Andrew M. Cuomo today announced in his State of the State address that he has issued an Executive Order aimed at redesigning New York's outsized Medicaid program. The order calls for the creation of a new Medicaid Redesign Team to find ways to save money within the Medicaid program for the upcoming state budget for the 2011-12 Fiscal Year.

Under Governor Cuomo's Order, the Team is to begin work no later than Friday, January 7, and must submit its first report with findings and recommendations to the Governor by March 1 for consideration in the budget process. The Team shall submit quarterly reports thereafter until the end of Fiscal Year 2011-12, when it disbands.

The Medicaid Redesign Team will include up to 25 voting members appointed by the Governor including:

State officers or state employees with relevant expertise.
Two members of the New York State Assembly, one recommended by the Speaker of the Assembly and one recommended by the Minority Leader of the Assembly.
Two members of the New York State Senate, one recommended by the Temporary President of the Senate and one recommended by the Minority Leader of the Senate.
Leaders with expertise in the healthcare industry.
Leaders with expertise in the healthcare insurance industry.
Business and consumer leaders.

New York State Medicaid Director Jason Helgerson will serve as the Team's executive director and the state Budget Director will serve as a non-voting member.

Cuomo News Release

Medicaid Matters Call for More Consumer Representatives on the Medicaid Design Team

Statewide Coalition Representing The Interests Of Medicaid Beneficiaries Recognizes

Dire Fiscal State Of The State, But Concerned With Cuomo's Approach

In advance of releasing its vision for Medicaid in 2011 and beyond, Medicaid Matters New York (MMNY) responds today to Governor Cuomo's first State of the State address with disappointment and dismay. The Governor's proposal for redesign of the Medicaid program through the work of a task force could have the potential to make great strides in improving the program. However, it is doomed to fail if no consumer advocates are part of the discussion.

"While we welcome a thoughtful redesign of the Medicaid program, the list of Redesign Team members mentioned by the Governor today is missing some key members," said Lara Kassel, Coordinator of MMNY. "The Governor's message appropriately emphasized the importance of returning power to the people and, in that spirit, he should include significant representation on the Redesign Team by advocates for the very people who would be impacted by change."

MMNY is a statewide coalition that includes a diverse and broad set of organizations united in their commitment to ensure that the interests of Medicaid beneficiaries are included, understood and met in any discussion on Medicaid. MMNY recognizes the incredibly dire fiscal circumstances in which the state finds itself, but is disheartened that the Medicaid program would be redesigned without including a consumer voice. The State of the State outline specifically mentions "consumer leaders," and the hope is that those slots will be filled by actual consumer advocates. The Governor must make his "people first" commitment continuous through all of his efforts, especially the Medicaid Redesign Team.

In the coming days, MMNY will release a paper for 2011 that will include the following recommendations:

Avoid across-the-board cuts to Medicaid providers
Ensure the utmost accountability and transparency in the use of Medicaid funds
Continue to simplify Medicaid enrollment and recertification
Allocate charity care funds based on actual service to the uninsured
Improve integration of behavioral health services into primary care
Promote consumer-directed long term care service models