A fast-working committee”™s proposals to reform Medicaid payments and programs in New York have raised both alarm and applause from health care providers in Westchester County and around the state.
Those critics and supporters have turned their sights and lobbying efforts on the state Legislature as it weighs adopting items from the lengthy Medicaid overhaul list into the 2011-12 state budget.
Gov. Andrew Cuomo”™s appointed Medicaid Redesign Team surprised many in the health care field and angered some when members approved 79 recommendations to the governor on Feb. 24, after less than a month of public hearings and committee meetings and several days ahead of Cuomo”™s March 1 deadline for their report.
While health care professionals sifted through the committee”™s 237-page package of recommended savings and program shifts, the governor”™s office said the report met the governor”™s spending target by introducing a cap of approximately $15.1 billion on state Medicaid expenditures.
Administrators at agencies providing home care services said the home care sector will bear a disproportionate share of the proposed Medicaid funding cuts.
Carol Weber, president and CEO of Visiting Nurse Services in Westchester, based in White Plains, said home care agencies face a potential $700 million “in catastrophic and structural overhauls in Medicaid” recommended by the committee. That would come on top of $434 million in cuts to home and community-based care in New York over the last three fiscal years, she said.
That $1.1 billion in actual and potential cuts “has really pushed health care agencies to the brink financially,” she said. With home care a less costly alternative to stays in nursing homes and other institutional care, “It just doesn”™t make sense,” Weber said of cuts she called “draconian.”
“The Medicaid redesign team was given only weeks to fix a Medicaid system that has been broken for decades,” Weber said. “They were given an impossible task.”
At Westchester Disabled On the Move Inc., Executive Director Melvyn R. Tanzman said the proposed changes will present “some real challenges” to persons with severe disabilities.
Tanzman said caregivers for the disabled were alarmed by the committee”™s proposal to abolish a loophole in state law that allows a spouse or parent to refuse to financially support an ailing spouse or child so that the patient can qualify for Medicaid. Eliminating the right of spousal refusal would save the state $28.3 million in the 2011-12 year and $56.5 million in each of the following three years, according to the committee.
For couples with fixed incomes, “That has a huge impact,” Tanzman said.
Tanzman said officials at his agency and at the New York Association on Independent Living in Albany also were concerned about the committee”™s leading cost-saving proposal, which would shift long-term patients receiving home care from certified home health agencies to managed-care plans. The change is expected to reduce use of home care services and costs, saving the state $100 million in Medicaid payments in 2011-12.
Tanzman, though, said managed-care providers could be expected to put profits over patients. “I think what”™s going to happen is that there”™s going to be a lot of cherrypicking going on,” with insurers looking to curb costs by serving those who need the least amount of services and discriminating against persons with the greatest needs.
Tanzman said institutions account for 70 percent of the state”™s Medicaid long-term care expenditures, while 30 percent are for community-based services. Yet the redesign team focused on the less costly community-based services. “It”™s backwards,” he said.
Dr. Joseph Tartaglia, president of the Westchester County Medical Society, said physicians were most excited by the Cuomo-appointed team”™s proposal to set a cap on non-economic damages in medical malpractice case. The committee proposed to cap those awards at $250,000, resulting in an estimated 24 percent decrease in malpractice insurance premiums for physicians and hospitals statewide. That amounts to a $384 million savings for hospitals.
The $250,000 cap has been effective in lowering premiums in other states but might be blocked by Sheldon Silver-led Democrats in Albany, said Tartaglia. “I really doubt that it”™s going to go through the Assembly,” he said.
