NY’s Budget, the MRT and Your Legislative Support for Smart, Safe and Effective Medicaid Cost Reforms

Governor Cuomo has reconvened the Medicaid Redesign Team (MRT) process from 2011. MRT II has been charged with again recommending Medicaid structural changes and savings, amounting to $2.5 billion.

As we noted in a press statement following the Governor’s January 21 budget announcement, “HCA understands the magnitude and seriousness of New York’s budget circumstances [which] is why we have already presented the Governor’s office and Legislature with ready proposals to support Medicaid cost efficiencies and relief,” noted HCA President and CEO Al Cardillo. “These cost offsets and reforms merit a voice at the MRT table.”

HCA is urging legislators and the MRT to embrace smart, safe and effective proposals to achieve Medicaid reform and, in so doing, reject any proposed slashes to home care or Managed Long Term Care (MLTC) which would have the unintended consequence of driving up costs in other areas of the budget.

It is important to stress that while the Administration has identified cost trends within certain programs, these individual trends do not exist in isolation but, rather, reciprocally. In fact, the first iteration of MRT broadened MLTC eligibility for cost restructuring purposes, so that these and other programs in the MLTC networks could serve to avert higher-cost institutional care — a trend that also otherwise coincided with a decline in fee-for-service utilization while meeting the the intended goal of expanding managed care enrollment.

The right policy changes can improve Medicaid affordability, advance health care and avert unnecessary cuts. HCA is therefore urging a set of proposals for consideration by the MRT, its appointees/representatives from the Senate and Assembly, as well as all legislators seeking to weigh in on the MRT process now and, ultimately, during the Senate’s and Assembly’s actions on the final MRT proposals.

Each of HCA’s proposals meets the Governor’s “directives” and tests, as outlined in his budget address, of zero impact on local governments, zero impact on beneficiaries, finding industry efficiencies and supporting integrity and accountability of services and programs.

Our Proposals

We’ve outlined preliminary versions of these proposals for you in recent months, and they comprise three main thematic areas:

  • Lower state Medicaid outlays first by optimizing Medicare-Medicaid coordination and usage. This means ensuring full entitled Medicare coverage for service payments that have been currently defaulting to Medicaid. One such means is a recent settlement entitling Medicare coverage for services previously excluded from Medicare (see a recent briefing on the Jimmo case here).
  • Improve cost controls and efficiencies by amending state laws and procedures to untie managed care plans’ and providers’ hands in key areas of cost and utilization control, streamline mandates, control program practices tied to higher costs, and tap existing private health insurance riders to increase coverage in lieu of Medicaid.
  • Leverage savings from home care intervention in high-cost/high-risk/complex care. Substantial and achievable cost savings can and should be scored — in favorable attribution to home care — for interventions in public health, prevention, and better health outcomes (especially avoided hospital, emergency room, and institutional care use) leveraged by home care interventions such as in sepsis, asthma, housing support, mental health, telehealth, pediatric care and others. HCA is ready to advance program specifics as well as scoring methods to support budget initiatives that provide high quality care and save costs.

Please look for further details of these proposals coinciding with HCA’s State Advocacy Day next week, along with other core resources such as HCA’s annual report on the financial and program condition of home care, hospice and MLTC. As always, we are happy to brief your office on these proposals or provide input on others that may emanate from the MRT process.