NYAPRS Note: A series of NYS Department of Health public hearings wrapped up yesterday on state proposals to reinvest savings from a variety of healthcare improvements that will be part of our waiver application to the federal government. See next week for a detailed copy of a list of recommendations for such reinvestments put forward by NYAPRS members that will be shared with Administration officials and advocates.
State Seeks Medicaid Cash In Waiver
Action Would Provide $17.1B For Innovative Programs, Officials Say
By Cathleen F. Crowley Albany Times Union June 20, 2012
New York state is asking the federal government for a big favor — a $17.1 billion favor, to be exact.
The state and federal government split the $54 billion cost of Medicaid, the public health program for low-income and disabled people, but statewide reforms have reduced the projected federal share by billions over the next decade.
As a result, the state is asking for a waiver that would allow New York to keep a large chunk of the federal savings and reinvest it in the Medicaid program.
The waiver request "is not a slam dunk," said Jason A. Helgerson, the state Medicaid director.
It's one of the largest Medicaid waiver requests ever, and contains some controversial ideas - like providing supportive housing to the sickest Medicaid patients.
If the waiver is approved, New York's Medicaid system could "make investments that otherwise would not be possible because of budget constraints," Helgerson said.
The state Department of Health is holding public hearings about the waiver, which is part of the process to secure it. A hearing was held Wednesday at University at Albany's School of Public Health in East Greenbush.
New York must demonstrate the reinvested money will be used to make Medicaid more efficient and cost-effective and, when the waiver expires after five years, not add expenses to the program.
During the hearing, Helgerson outlined 13 ways the state plans to spend the money, which amounts to about $2 billion a year. In general, the initiatives call for reducing hospital beds in exchange for outpatient services and stronger primary care networks, placing the most complex patients into coordinated care programs, ending fee-for-service Medicaid payments in favor of managed care models, and financially stabilizing safety net providers.
Hospitals, nursing homes, health clinics and medical providers with initiatives that fall into the categories could apply for money, but the money will not be used for normal operating expenses. "It can't be business as usual," Helgerson said.
Lara Kassel of Medicaid Matters New York criticized the health department for publishing a nine-page summary of the waiver application rather than a complete draft. Kassel also said the primary care initiatives seemed too centered on hospitals, rather than community organizations that already have experience with outpatient care.
Dr. Peter Nelson, CEO of the Joseph P. Addabbo Family Health Centers in Queens, said the state's proposal looked comprehensive, but he had two more ideas. Health providers, Nelson said, need technical help with adopting electronic records and new management models that the state wants. He said the state should create technical teams to provide free assistance. Also missing from the state's proposals was a plan for teaching Medicaid enrollees to improve their own health, he said.
Nelson envisions "health coaches" who would train people to manage their own chronic diseases and better understand the components of a healthy lifestyle. "The money could help develop a new type of worker in the health care arena," Nelson said.