HCA Advances Budget Relief, Reform Proposals amid Medicaid Crunch

Recent media reports and statements from the Governor and Comptroller point to a multi-billion-dollar gap in the state’s Medicaid budget.

The state’s Medicaid system needs stable, predictable and sound financing to effectively meet the clinical needs of patients enrolled in state-sponsored health care. This also means covering what it costs home care and other providers who are delivering on that care, including the many cost obligations that come directly from state administrative or labor and wage requirements for which Medicaid is liable.

And yet two-thirds of home care and Managed Long Term Care organizations certified or contracted to bill Medicaid in New York State are operating in the red. Medicaid enrollments continue to rise — as do enrollments within specific Medicaid home and community based programs — in ways that have exceeded the state’s projections because a need seriously exists for these services.

Indeed, patients receiving long term care or hospital after-care at home have higher acuity than ever before — meaning they are sicker and sicker — with over 62 percent of patients in home care suffering from five or more chronic conditions.

The Executive and Legislature have many avenues to address the budget gap. HCA is urging a first resort of cost offsets that leverage the strengths of home and community-based services.

HCA Proposals at a Glance

In recent weeks, HCA’s policy leaders have discussed with Executive and Legislative leadership offices an array of budget relief and reform proposals. Our proposals would better:

  • Address statutory barriers to cost control and efficiency that can relieve Medicaid costs.
  • Support alternatives to Medicaid (including expanded rider coverage for private or commercial coverage) to pay for long term care.
  • Maximize federal Medicare coverage (including for the dual-eligible population that is covered both by Medicaid and Medicare) — in cases where Medicare has primary responsibility — before tapping Medicaid coverage.
  • Mobilize preventive or chronic-care management tools in home care and hospice that can further prevent hospitalizations or other high-cost service use.

HCA is happy to brief your office and provide greater detail on each of these proposals which offer real and substantial cost offsets relative to the home and community-based care areas of the budget. Please contact HCA’s Director for Public Policy and Advocacy Alyssa Lovelace for more information at alovelace@hcanys.org or (518) 810-0658.