State Budget Provision Would Leave Managed Medicaid Patients Out to Dry
With March now upon us, it’s crunch time for the Assembly and Senate’s one-house budget resolutions. Albany watchers and lawmakers alike know that the proposed Medicaid cuts in Gov. Kathy Hochul’s $233 billion executive budget proposal have been a hot topic. For example, Sen. Gustavo Rivera, chairman of the Committee on Health, led a rally back in January with fellow legislators, hundreds of SEIU Local 1199 union members, and others opposing the governor’s planned $1.2 billion cuts to Medicaid. Kudos to Sen. Rivera for his commitment to protecting Medicaid beneficiaries.
However, there is a seemingly small provision related to Managed Medicaid patients in the governor’s budget proposal that has been flying under the radar. If enacted, it will have devastating consequences for these patients. Members of the Assembly and Senate, along with their constituents, need to quickly learn what is going on here. Simply put, this provision is not ready for prime time.
At issue is Part H of the Executive Budget Health & Mental Hygiene Article 7 legislation. It would eliminate the ability of physicians and hospitals to bring a claim to the state’s independent dispute resolution (IDR) process for public health insurance plans. Enacted in 2014, New York’s IDR process was the nation’s first. The state’s Financial Services Law that set up this process went on to serve as the model for the federal IDR process enacted in 2020.
What’s at stake for patients should this prohibition on IDR access succeed? If legislators put this provision into the final state budget, then 5 million Managed Medicaid beneficiaries will lose access to essential on-call emergency department care and immediate surgical care in hospitals across the state. These Managed Medicaid patients might be forced to transfer to public hospitals, many of which are already financially-stressed safety net hospitals deeply in debt. They will also be denied the same high-quality services that other patients receive. Additionally, if Managed Medicaid insurance companies are no longer compelled to make any payments for medical services due to this scrapping of IDR, Managed Medicaid patients will suffer a severe decline in their access to care. These are certainly not winning campaign messages for lawmakers.
Without a doubt, those with Medicaid Managed Care (MMC) Plans should be troubled by this proposal. Over the last decade, the state has moved many Medicaid patients into them. These plans, such as Fidelis, HealthFirst, and MetroCare, cover Medicaid beneficiaries in exchange for payments from the state’s Medicaid program.
Given that leaders in Albany have been rightfully emphasizing the importance of health equity and justice, it’s shocking to even see this in the executive budget. As outlined above, this minor provision would have enormous implications. In effect, it creates a two-tiered health system in the state. Additionally, it would enshrine Medicaid inequity at a time when an increasing number of New Yorkers are enrolling in these MMC plans.
The Hochul administration also claims this budget provision will save the state $7.5 million. Doing the math, that amounts to 0.003% of the state budget in return for destroying Managed Medicaid benefits.
As Members of the Assembly and Senate continue working on their one-house bills, it’s essential that they don’t jeopardize the access of single mothers, seniors, and others on Managed Medicaid plans to the services and treatments they need. It is hoped that lawmakers recognize now is certainly not the time to pass this Part H provision. Reducing health benefits for the state’s most vulnerable citizens is the opposite of health equity and justice.
Christopher Sheeron is founder and president of Action for Health and the State Care Network
