Medicaid Reform in NYS

In his State of the State address on January 7th, Governor Andrew Cuomo called for a redesign of the Medicaid program. The goal of Medicaid redesign is to cut the cost of the program which is the most expensive in the nation. The governor stated that he also wanted to see the program have better overall outcomes. In essence, he wants a better program for less money. To accomplish this goal, Gov. Cuomo is using a model that was successfully used in Wisconsin. The plan relies on all the various stakeholders involved with Medicaid to work together to draft a reform plan that meets specific benchmarks set by the Executive Budget. It is pretty obvious that the Governor hopes to build a consensus plan that will both meet the needs of true reform while maintaining a level of services that adequately meets the needs of Medicaid recipients.

On January 9th the Governor named the members of the Medicaid Redesign Team and soon after a website went live located here. The team is made up of representatives from the state legislature and state agencies such as the Department of Health which is on point for the project, representatives of healthcare industries such as hospitals and insurance companies, and representatives from healthcare unions, and consumer organizations. The team has already begun holding meetings and a number of regional forums are being held across the state in order to seek advice from the public. Oral and public testimony is being solicited from the public. We urge everyone to make their voice heard by providing comments and testimony on the aforementioned website.

Obviously the disability community is very involved in this process. The New York Association of Independent Living (of which NCCI is a member) and the Center for Disability Rights have produced a very thorough brief that makes substantive proposals for Medicaid redesign, supported by hard data. We encourage people who want to provide comments to the Redesign Team, feel free to use this paper to frame your arguments. The main points of the recommendations are as follows:

• Increase utilization of the Nursing Home Transition and Diversion Medicaid Waiver to transition people from nursing facilities to community living.

• Establish an expedited enrollment process for the Nursing Home Transition and Diversion Waiver and the Traumatic Brain Injury Waiver in order to divert placement in nursing facilities.

• Implement the Community First Choice Option and shift people from the traditional Personal Care Program (PCA) into the Community First Choice state plan program.

• Where possible, shift recipients of Certified Home Health Programs into the Consumer Directed Personal Assistance Program (CDPAP).

• Expand the pool of direct care workers in the Consumer Directed Personal Assistance Program (CDPAP) to match the federal rules for paid family caregivers, which would promote use of the program.

• Better utilize assistive technology to reduce personal care spending.

For more details about each of these points along with detailed supporting data please click here to see the NYAIL/CDR Recommendations. Keep in mind that there are multiple goals in the above proposals; fully implement the Olmstead Supreme Court decision of 1999 that ordered states to move from segregated institutional placements to integrated community living placements, keep services intact, and cut costs to Medicaid. This is a tall order but as the data bears out, the above proposals would help accomplish these goals.