New York Pays Health Plans in Full for the Medical Equipment My Company Provides. But We Only See A Portion of that Money.
For the past 40 years, my company has delivered wheelchairs, hospital beds, oxygen equipment, and other home medical supplies to Medicaid patients across Central and Western New York. We fit the elderly woman down the road for a hospital bed so she could recover at home instead of a nursing facility. We keep a young father’s ventilator running so he can be there for his kids. This is the work my staff and I do every day, and we’re proud of it.
But I’m going to be honest about something most people outside this industry don’t know: for a lot of this work, we’re being paid 60 to 70 cents on every dollar the state actually allocated to cover it.
Here’s how it works. New York’s Medicaid program pays managed care health plans a set monthly amount per patient to cover their care, including equipment like ours. That payment is calculated using the state’s official Medicaid rate — the same rate that’s been on the books, largely unchanged, since 1987. But once that money lands with the health plan, nothing requires the plan to pass the full amount on to the business that actually delivers the equipment. So plans keep a share of it, and companies like mine get the rest.
I’m not describing a rare case. It’s the norm. And it’s why New York has lost roughly 24 percent of its DME suppliers since 2013. When a company like mine can’t make the math work, we don’t get to negotiate a better deal. We close, or we stop taking new Medicaid patients. Either way, the person who needed a wheelchair or an oxygen tank is the one left without options.
There’s a bill awaiting Governor Hochul’s desk that requires Medicaid managed care plans to pay DME providers no less than 100 percent of the state’s existing Medicaid rate for the same equipment. Not a rate increase. Not new state money. Just the rate that already exists, actually reaching the business that earned it.
I understand why a “no new cost” claim sounds like something to be skeptical of — I’d be skeptical too, if I hadn’t looked at the numbers myself. The Governor vetoed this same bill last year, citing a $145 million cost. But that number came from a narrow comparison: what plans currently pay out in claims versus what they’d pay at the full rate. It never looked at the other side of the ledger — the $515 to $545 million the state already pays health plans every year specifically to cover this equipment. The state’s own Health Department has confirmed this in writing. When you look at the full picture, the money to pay this bill’s rate is already in the system. It’s just not required to go where it’s supposed to.
I’m not asking the state for a favor. I’m asking that the money already set aside for my patients’ equipment actually reaches the business that provides it — my company, and the others left doing this work across the state. Every year this doesn’t happen, we lose more suppliers, and more New Yorkers lose access to equipment that keeps them safe, independent, and out of far more expensive hospital beds and nursing homes.
I’d ask anyone reading this to contact the Governor’s Office and ask her to sign S.8838-A/A.10576. It costs the state nothing it isn’t already spending. It would mean everything to the businesses and patients depending on this equipment to get through another year.
John Quinlan, Owner of Quinlan’s Medical
