New York Medicaid Redesign Team Efforts Fall Short

On December 13, 2011, the Medicaid Redesign Team met to hear remaining workgroup recommendations for a full report that is due to Governor Cuomo on December 31.  Advocates remain skeptical that the redesign process can reduce overall spending on long-term care without jeopardizing access to community-based services for individuals with disabilities.  Individuals with disabilities are entitled to receive health, employment, and education services and supports in an integrated setting appropriate to their needs according to Title II of the Americans with Disabilities Act.  Typically, people prefer their own home, yet New York State has developed a Medicaid funding priority that favors institutional settings.  Neither the Governor nor Medicaid Redesign Team members have directed legislative action that is necessary to correct this situation. 

The Medicaid Redesign Team was created by Governor Cuomo earlier in the year to develop strategies to bring the Program’s spending to more sustainable levels and to improve patient health outcomes.  Many reform recommendations  are already being implemented across the state under a global spending cap set in the state’s 2011-2012 budget process.  Previous cuts to homecare providers of 2% this past year, also threaten access to long-term care services for individuals with disabilities as agencies struggle to meet the needs of patients and workers.  Some highlights of the Medicaid Redesign workgroups and their recommendations to date include:

·        Program Streamlining – creation of a state insurance exchange, centralize eligibility and enrollment, establish asset verification system, and phase-out local share of Medicaid responsibility

·         Behavioral Health – will transition slowly to managed care, increase use of health information technology, create of specialty behavioral managed care organizations, and payment incentives based on health outcomes

·         Managed Long-term Care Implementation and Waiver  – principals have been developed for a new care coordination model, development of statewide quality measures  to reduce admissions

·         Health Disparities – establishment of data collection standards and improving access to language services

·         Basic Benefit Package – align state coverage to federal grading mechanisms and eliminate non-evidence-based benefits

·         Workforce Flexibility/Scope of Practice – promote the consumer directed personal assistance program and define the scope of practice for healthcare professionals

·         Payment Reform and Quality Measurement  – Integrate Medicaid and Medicare service delivery and financing for dual eligibles, adopt state-wide performance measures

·         Affordable Housing – new investments in affordable housing, creation of a formal mechanism to direct savings from redesign to housing, stream-lining of assisted living to improve access, a de-linking of nursing home bed reduction with the creation of assisted living beds.

-          Donna G.