New York Medicaid proposes reforms to improve access
New York Medicaid proposes reforms to improve access
New York's Medicaid program has identified increased access to primary and preventive care and other ambulatory care services as a priority, says Deborah Bachrach, Medicaid director and deputy commissioner of the Office of Health Insurance Programs for the New York State Department of Health.
New York's hospital inpatient rates are among the highest in the country and exceed the reported costs of hospital care for Medicaid patients. At the same time, Medicaid rates for ambulatory careemergency departments, physicians, clinics, and primary careare well below costs.
Ms. Bachrach notes that New York ranks high among states on unnecessary hospitalizationshospitalizations that could have been avoided if New Yorkers had timely access to good primary and preventive care.
In light of this, the state's Gov. David Paterson has embarked on a multiyear strategy to reform and reduce inpatient rates and reallocate the monies to higher reimbursement rates for ambulatory care providers.
In last year's budget, Gov. Paterson invested more than $300 million in ambulatory care services, with enhanced payments to primary care providers that maintain weekend and evening hours or practice in underserved areas of the state. Building on these reforms, this year's executive budget proposes to invest an additional $300 million in outpatient settings, further increasing reimbursement levels for hospital clinics, community health centers, and physicians.
Additional payments will be made to clinicians and clinics that meet medical home standards and provide coordinated care and continuity of care for their primary care patients. "A medical home demonstration will be established to support the development of health care homes in the Adirondack Park area, in order to improve quality and access in this underserved area of the state," reports Ms. Bachrach. "The investment in ambulatory care will be funded with reductions to inpatient rates."
Coverage expansion planned
At the same time, the governor's executive budget seeks to reform the inpatient reimbursement methodology to ensure that inpatient dollars support cost-effective, quality care.
Ms. Bachrach says the goal is to reform Medicaid reimbursement to ensure that Medicaid is paying for the right care, in the right setting and at the right price, and most particularly to ensure that New Yorkers have timely access to primary and preventive care.
More than 4 million low-income New Yorkers have access to comprehensive health care through New York's Medicaid program, says Ms. Bachrach. Because many families with working parents are uninsured, in 2008, New York expanded its State Children's Health Insurance program, making affordable coverage available to every child in New York.
Currently, an estimated 2.5 million New Yorkers do not have health insurance. "Now, Gov. Paterson will partner with the federal government to expand Family Health Plus to 200% of the federal poverty level, making more than 400,000 additional New Yorkers eligible for coverage," says Ms. Bachrach.
To fund this initiative, New York will request a waiver from the federal government to allow the state to tap into $30 billion of savings the state has already achieved in the Medicaid program. Ms. Bachrach says because New York's Medicaid reform goals are consistent with those articulated by the new federal administration, she is optimistic that New York will be able to develop "a robust partnership with the federal government to expand coverage, contain costs, and improve quality."
Another proposal that Gov. Paterson is advancing is to expand health insurance coverage for family members up to the age of 29, as 31% of New York's uninsured are ages 19 to 29. Although New York law does not require employers to offer dependent coverage, employers who do choose to offer coverage typically offer parents coverage for dependents through age 18 for everyone, and through age 22 if attending college. Gov. Paterson's proposed legislation expands coverage to family members from ages 19 to 29 regardless of whether they attend college.
"This would be a COBRA-like benefit," says Ms. Bachrach. "Families, not employers, would be required to pay the full cost of the policy. But the policy would cost significantly less, since it would be offered under a group policy, and it would be age-rated. Based on New Jersey's experience, families could expect to pay 20% to 40% less than current COBRA rates."
Goal is to remove barriers
The long-term goal is to remove barriers to coverage until every New Yorker who is eligible for publicly-funded coverage is enrolled. To make it easier for eligible New Yorkers to get and keep coverage, the asset test and the finger printing requirement may be eliminated, as well as the requirement that applicants appear for a "face-to-face" interview.
The proposed budget also would increase the amount of funding available for hospitals, community health centers and community mental hygiene clinics serving increasing numbers of uninsured patients; it also would add $282 million to the Hospital Indigent Care Pool. Over 50% of those funds will go to subsidize state public hospitals, and double funding for the state's Diagnostic and Treatment Center Indigent Care Program from $55 million to $110 million through a federal waiver.
"If successful, we will include community mental hygiene clinics in the program," says Ms. Bachrach. "In addition, we will pay enhanced amounts for clinics and clinicians that meet medical home standards. Finally, we are proposing to increase the indigent care pool to provide greater support to hospitals and community health centers serving uninsured patients."
Contact Ms. Bachrach at (518) 474-3018 or [email protected].New York's Medicaid program has identified increased access to primary and preventive care and other ambulatory care services as a priority, says Deborah Bachrach, Medicaid director and deputy commissioner of the Office of Health Insurance Programs for the New York State Department of Health.
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