May 10, 2023

Given that major New York-licensed insurers reported roughly $15.8 billion in invested assets, $45 billion in revenue and $6.5 billion in administrative expenses in 2020, we think the state should demand more from insurers in terms of their power to address health inequities in the healthcare system here in New York, and around the country.

The United Hospital Fund, a nonprofit currently helmed by former New York City Health Commissioner Oxiris Barbot just released a new Report that highlights ways that local insurers should support specific health equity initiatives and examples of how some of them have done so. See attached Report.

Clean Slate Act looms as end-of-session issue

BY ELEONORA FRANCICA, POLITICO | 05/09/2023 05:11 PM EDT

ALBANY, N.Y. — Lawmakers and advocates are again pushing for the passage of legislation to seal formerly incarcerated people’s conviction records.

Key Context: The Clean Slate Act is expected to be one of the key issues to be debated ahead of the end of the legislative session June 8. The bill passed the state Senate last year, but stalled in the Assembly.

The measure would seal former incarcerated people’s conviction records after three years that the sentence is completed for misdemeanors and seven years for felonies.

The coalition rallied on Tuesday at the state Capitol, calling on lawmakers to pass the bill in the Assembly by the end of the session.

According to the group, the bill would help 2.3 million New Yorkers with previous convictions find work and housing.

In 2020, the Harvard Law Review released a study on a Michigan law that provides for cleaning formerly incarcerated people’s records within two years. The study showed 11 percent of people were more likely to find a job, 25 percent had a higher salary, and overall, they were less likely to commit a crime.

Why it matters: The bill would eliminate the restrictions and disqualifications that formerly incarcerated individuals face even after their debt to society has been satisfied, supporters said Tuesday.

They said that formerly incarcerated people face a lifetime of rejection, including termination from housing and employment.

The Clean Slate Act would decrease the unemployment rate in New York and increase economic growth, as well as improve racial equity, advocates said.

“When 400,000 New Yorkers are arrested a year and have criminal charges, and when 80 percent of people who are arrested and incarcerated are black and brown, we know exactly who we’re talking about and who we would not be serving if we did not pass this (bill),” Sen. Kristen Gonzalez (D-Queens) said.

What they say: The bill has gained the support of business leaders across the state, including labor unions, major corporations like Con Edison and leading business organizations, such as the New York State Business Council.

“The formerly incarcerated nationwide unemployment rate for formerly incarcerated individuals is 27 percent. During the pandemic, the highest we got as a country was 15 percent,” Paul Zuber, executive vice president of the Business Council, said during the rally.

New York is currently facing a 421,000 unfulfilled jobs issue, Zuber noted. He said a byproduct of the bill would be making New York safer, saying he thinks people would not commit crimes once they have economic stability.

“This is not about letting people get away with a crime,” said Assemblymember Catalina Cruz (D-Queens), the Democratic sponsor of the measure. “This is about letting people who have paid for that crime get a real life.”

Republicans have railed against the measure, saying it would limit the ability of employers and landlords to know the background of people they interview.

What’s next: Last Tuesday, Assembly Speaker Carl Heastie (D-Bronx), signaled the bill would be considered before session ends.

“We will definitely consider Clean Slate before the end of session … It helps public safety,” Heastie said. “It helps deal with the issues of a workforce.”

Others were more hopeful.

“Five weeks left of session. We got to get it done. No excuses,” Deputy Senate Majority Leader Michael Gianaris (D-Queens) said at the rally.

May 10, 2023 05:30 AM 2 HOURS AGO

Providers push state Supreme Court to stop 340B carve-out, demand emergency funding

JACQUELINE NEBER

Plaintiffs have renewed their attempt to stop New York’s controversial 340B drug program carve-out in a lawsuit against the state Department of Health and its commissioner, James McDonald.

Heritage Health and Housing and Evergreen Health, two providers that participate in the program, have filed a request for preliminary injunction that asks the court to rule that the carve-out is illegal. They allege that it impinges upon the function of the 340B program and violates the Affordable Care Act, provider and patient rights, and the rights of patients and the providers under the state constitution, according to documents filed in the lawsuit.

The lawsuit also claims that because many providers that participate in the 340B program serve mainly vulnerable New Yorkers, the switch puts marginalized people at risk.

Heritage and Evergreen originally filed a request for a temporary restraining order in March. But the transition and carve-out went into effect April 1, despite monthslong protests from health care organizations across New York.

Now the plaintiffs argue that providers such as themselves are already losing money since the carve-out went into effect because they are now required to bill at the acquisition cost for drugs they get through the 340B program, thereby losing the revenues from the program they were able to make under the managed care model.

“[The carve-out] affects everybody in New York, but the impact disproportionately affects the LGBTQ+ community and also disproportionately impacts minority communities,” Sandra Gale, the chief executive of Bronx-based Heritage Health, told Crain’s. “It also runs contrary to any mission statement found on the Department of Health’s website in terms of having health equity.”

Last month federally qualified health centers and Ryan White HIV/AIDS programs said they had lost $5 million as a result of the switch.

Before the carve-out, the Health Department said the state would make providers “whole” by reinvesting money back into organizations affected by the carve-out. Previously under managed care, providers worked with third parties to dispense the discounted drugs to patients. After reimbursement, everyone got a share and the remaining profit went back to the provider, state Medicaid director Amir Bassiri told Crain’s in February.

The switch could wind up making money for providers because the state will cover the cost of the drugs and the professional dispensing fee, which will be included in the reinvestments to providers, Bassiri added.

According to legal documents, the Health Department has so far only identified some federally qualified health centers that should receive supplemental payments, and the draft list excluded about a dozen providers that should also be eligible. The department has yet to announce a detailed plan for how it will reimburse providers, the plaintiffs’ memorandum of law in support of their motion said.

“DOH had two years to get this right,” Dr. Danielle Milano, chief of medical affairs at Heritage House, said in an April affidavit. “If DOH officials had truly engaged in the sort of ‘calculated and meticulous planning’ which Mr. Bassiri puts forth in the affidavit that he submitted in opposition to plaintiffs’ [initial] application for a temporary restraining order, how could such an obvious and widespread oversight occur?”

With regard to the original request from March, Bassiri said in his affidavit that there was “no way to separate 340B from the NYRx Transition, nor is there any way to temporarily halt the transition without jeopardizing the ability for all Medicaid managed care members from being able to access their prescriptions on April 1st.”

In addition, Bassiri said New Yorkers who are Medicaid managed care members would not lose access to affordable drugs or coverage as a result of the carve-out.

The plaintiffs say that Bassiri’s characterizations were misleading, with Sandra Gale calling them “misrepresentations” and “material omissions made before that judge in a court of law.”

“I fervently believe that there’s not one legislator that would have allowed this nonsense to become effective [at] 12:01a.m. on April 1, had they known really what was going on,” she said. She called for the state to provide emergency funding to affected providers as soon as possible.

Health Department representatives declined to comment on pending litigation. But one representative, Cadence Acquaviva, said more than $900 million would be reinvested in providers now that the state budget has passed.

“The department is confident that funding will be distributed prior to providers experiencing significant cash flow challenges and recommends that any provider treating an individual in need of additional services reach out to the department directly to help and-or connect that individual to supportive services,” she said.

Ryan White providers will receive up to $50 million in reinvestments, federally qualified health centers will get up to $270 million and hospitals up to $600 million, she continued, and the department will ensure the funds are not diverted from the providers.

These reinvestments will reimburse providers “well beyond” their estimated losses, she said, and the health department is using the Health Resources and Services Administration database to determine which providers are eligible for reinvestments.

The department is in the process of submitting the reinvestment plan to the Centers for Medicare and Medicaid Services and expects timely approval, Acquaviva added.

At least nine leaders of health care organizations in the state have submitted affidavits criticizing the effects of the carve-out as part of the lawsuit. They include representatives from Housing Works, the AIDS Service Center of Lower Manhattan, the Harlem United Community AIDS Center and Evergreen Health and Heritage.

Gale and Michael Lee, chief operating officer of Evergreen Health, sent a letter to state Attorney General Letitia James and Inspector General Lucy Lang on April 19 calling on them to ensure the plaintiffs will not be the subject of illegal retaliation or retaliatory conduct by the Health Department.

Brian Culnan, an attorney for the plaintiffs, said that because of the briefing schedule between the parties, the state’s papers are due June 2 and the plaintiffs can submit reply papers 12 days after that. If the judges wishes, the parties could have an oral argument in late June, he added.

“We are not going to settle down,” Gale said. “The community is growing in its voice in opposition against what happened here.” — Jacqueline Neber