New York’s Medicaid Quality Incentive Program Must Be Preserved

By Eric Linzer, President and CEO, New York Health Plan Association | February 2, 2024

Improving the quality of care for individuals enrolled in Medicaid and addressing inequities in care requires investment. One approach that has proven to work in New York has been the Medicaid Quality Improvement (QI) Program.

The QI Program incentivizes efforts aimed at addressing the core causes of health disparities and improving health outcomes for underserved populations. Health plans are measured on their ability to achieve performance metrics that the State sets.

This can include measuring whether pregnant individuals receive timely pre- and post-natal care, that children and adults receive appropriate preventive care and screenings, and home-bound individuals receive care to keep them healthy and out of the hospital. Health plans only receive incentive funding for achieving results that meet or exceed State metrics, and partner with providers and community organizations on programs that benefit low-income New Yorkers. Funding helps to support a broad range of programs across the state. Among them:

  • Connecting high-risk pregnant women with registered nurses and community health workers in Brooklyn;
  • Diabetes management efforts that have helped patients lower their A1C levels in the Bronx;
  • Extending offices hours at a pediatric practice on Long Island to expand access and improve compliance with well care visits, mental health screenings and vaccinations;
  • Housing and food support to help homeless and low-income families achieve sustainable independence in the Capital Region, and
  • Identifying Medicaid members in Buffalo who are not accessing health care services and providing in-home visits to ensure they get the care they need.

These efforts are not just making the quality of care better for more than 5 million New Yorkers enrolled in Medicaid. By working in partnership, providers, community-based organizations and health plans are addressing the social factors that create barriers to equitable care for residents from Brooklyn to Buffalo.

Unfortunately, funding has been consistently reduced or eliminated during the state budget process over the past several years. Gov. Kathy Hochul’s budget proposal eliminates funding for the QI Program, cutting $268 million. In a Medicaid budget that totals nearly $100 billion, this is penny wise and pound foolish. The investments health plans, providers and community organizations are making to improve the health of the state’s most vulnerable individuals more than pays for itself. Recognizing the importance of this program, in December the Black, Puerto Rican, Hispanic, and Asian Legislative Caucus endorsed full funding for the Medicaid Quality Incentive Program in the 2024 People’s Budget.

It’s vital that the final state budget restores and fully funds the Quality Incentive Program to enable providers and community organizations to continue and enhance these innovative approaches that have been shown to improve the quality of care and ensure high-quality, equitable care is accessible for residents throughout New York.