HEADS UP! Advocacy opportunity for NYS Council members in lower Hudson region:
New York Rep. Mike Lawler has scheduled an in-person town hall this Sunday. The town hall is happening on Sunday, April 27 at 6 PM at Clarkstown South High School, 31 Demarest Mill Rd, West Nyack – doors open at 5:15 and the event begins at 6pm. RSVP is required, visit NY17TownHall.com to sign up. Attendance is limited to constituents willing to show ID.
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FEDERAL ADVOCACY RESOURCE
Turning to Congress, this final week of recess is CRUCIAL in our advocacy efforts to protect and defend Medicaid from these potentially disastrous cuts. Thank you for all of your advocacy efforts during week 1! May 7 has been set as the target date for committees to finish their markups, with the House Energy and Commerce Committee potentially meeting as early as May 5 to begin its work. Speaker Johnson’s goal remains to move forward with reconciliation by Memorial Day.
Health Action Resource List
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- Families USA recently published our Health Action Resources List on our website, in which we compile resources from our partners for all of you to access in one place. You can find that page here.
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State Budget Progress
Summary: Gov. Kathy Hochul and legislative leaders tentatively hope to announce a deal by the end of this week for the spending plan that was due April 1, said the two officials. That could allow budget bills to be passed early next week before the budget, expected to total more than $252 billion, becomes a full month late. (Newsday)
More from State of Politics: State lawmakers bought themselves another two days to pass a state budget, now 22 days late. They passed an extender to bridge the funding gap for state services and payroll from Wednesday when the current extender expires, through Thursday.
Deputy Senate Majority Leader Mike Gianaris told reporters the most likely scenario at this point seems to be a budget deal later this week with voting on budget bills spilling into early next week.
“I think next sounds like a really good week to pass a budget,” he said. “I think the hope at this point mid-week is to reach an agreement this week and pass it next, that would be a nice outcome if we can get there.
That means the grind of negotiating policy issues, which has been the sole reason for the holdup thus far, must be wrapped up this week. Same goes for how the billions of dollars the state plans to spend will be allocated, with the final number still undetermined. Therefore also up in the air is school aid, aid to municipalities, and how issues of revenue, taxes, and tax relief will be addressed.
Gianaris said he’s confident a compromise will come on changes to involuntary commitment laws.
“All that stuff will come together,” he said.
When it comes to the governor’s late-in-the-game budget push for legislation around the wearing of face masks in the commission of a crime, he said concerns of members are being conveyed to leaders. Whether that proposal will make the final package in any form is unclear, but it’s almost certain that it won’t be in the form that Hochul initially proposed.
State Sen. James Skoufis told Spectrum News 1 Monday the proposal has at the very least been steered away from a full blown criminal charge, now being discussed as a “penalty enhancer” to be considered during sentencing.
Multiple lawmakers said the modified proposal hadn’t been presented to members as of earlier Tuesday, but there is a sense it could ease concerns over mask use related to religion, immigration, and protest.
It comes after Gov. Hochul downplayed her push for the policy over the weekent, emphasizing that it was a late add and could be dealt with through legislation later in session.
Gianaris said that’s an option.
“The members of the public believe, if you believe the Siena poll this morning it’s the one issue that the public said they would prefer not to be taken up in the budget,” he said. “We have a month and a half of session left from now so we have time to do a lot of things.”
The poll also found that of Hochul’s primary budget proposals, 61-19% support restricting student cell phone use in schools, 64-24% support making it a crime to wear a mask to conceal identity while threatening someone, 43-24% support amending the state’s discovery laws and 45-31% support making it easier to involuntarily commit someone with mental illness.
A majority of those who support discovery changes said Hochul was right to hold up the budget for that issue, with a plurality supporting a budget holdup for cell phone restrictions and involuntary commitment. A plurality of those who support a mask ban said they didn’t think it’s worth holding up the budget.
Meanwhile, lawmakers like Assemblyman Angelo Santabarbara continue to express frustration that discussions on fiscal matters like school aid and aid to municipalities have been held up for weeks in favor of the governor’s policy propositions, but that frustration is compounded by the fact that having to vote on budget bills stifles the opportunity for debate on individual policy pieces within them.
“We see a policy piece be put in the budget that’s a controversial piece, and on top of that once it is settled, when you vote you’re voting on school funding but you’re also voting on this policy piece at the same time, that’s really unfair,” he said.
Lawmakers will be back to pass another extender on Thursday which will provide a window into the weekend should the budget be teed up for a vote, but at least an additional extender could be required to get the budget over the finish line.
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(Politico, 4/23)
Gov. Kathy Hochul and legislative leaders are hammering out an expansion of involuntary commitment— but rules around when patients can be discharged are still the subject of debate, according to a person familiar with the status of negotiations.
The person, who was granted anonymity to speak freely about ongoing and sensitive talks, said Hochul, Assembly Speaker Carl Heastie and Sen. Majority Andrea Stewart-Cousins are working on the terms of a deal that would require a medically trained professional to respond to cases that involve an involuntary commitment when feasible.
It’s one of the final sticking points in budget negotiations among the three Democrats as they work behind closed doors to hammer out an agreement on a proposed $252 billion spending plan that is more than three weeks late.
Hochul — whom Republicans criticize as being soft on crime ahead of her reelection next year — is pushing to lower the standard for hospitals to involuntarily commit mentally ill people.
“We cannot allow our subway to be a rolling homeless shelter,” she said in January, referring to New York City’s sprawling mass transit system.
State law limits involuntary treatment to when a person is deemed at substantial risk of physically harming themselves or others. Hochul’s proposal would expand its use to instances when individuals can’t provide for their “essential needs, such as food,clothing,medical care, safety, or shelter” due to a mental illness.
Mental health advocates say her proposal would force patients into a system that is not equipped to handle their needs.
“The false narrative that’s being presented to us is you have to choose between limiting people’s rights or limiting people’s safety, and that if you keep people’s rights whole, you’re somehow jeopardizing the public,” said Harvey Rosenthal, the CEO of the Alliance for Rights and Recovery. “That’s not true. You can do both.”
State officials are also exploring ways to codify the terms of a Monday settlement between the state and WMCHealth, which is accused of discharging patients without adequately evaluating and stabilizing them.
The $400,000 settlement requires the health system to implement new protocols for using restraints and medications to treat agitated patients, according to the state attorney general’s office. The health system also pledged to deploy peer counselors in its emergency rooms, make mental health providers available at primary care clinics, expand substance use disorder treatment and make post-discharge follow-up calls to patients who are screened for a moderate or high-risk of suicide.
Of Hochul’s four priorities, three are related to public safety. Lawmakers have already come around to a version of her proposal to change criminal discovery laws, though her push to restrict mask wearing in public is facing headwinds.
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Medicaid work requirement lessons from Arkansas, Georgia
MICHAEL MCAULIFF, Modern Healthcare, 4/23
Republicans eyeing deep cuts to Medicaid are considering imposing work requirements on some beneficiaries.
This policy’s track record suggests it may not produce the savings the GOP craves without making a lot of people uninsured and subjecting providers to unpaid medical bills.
The concept of work requirements is generally popular and they already apply to other programs, such as food and cash assistance, dating to “welfare reform” in the 1990s. As the congressional Republican majority begins to assemble a huge legislative package to extend expiring tax cuts enacted during President Donald Trump’s first term, they are leaning into making “able-bodied” adults work to earn healthcare.
The leading proposal is based on the Limit, Save, Grow Act of 2023, which passed the House in 2023 but was not considered by the Senate, which had a Democratic majority at the time. House Republicans revived this plan in January as part of a menu of trillions of dollars in possible budget cuts.
That bill would have mandated work or community service for people aged 19-55 who were not already working, disabled, in school, caring for a relative or undergoing rehabilitation for substance use.
The House GOP estimates Medicaid work requirements would reduce federal spending by $100 billion over 10 years. Republicans aim to reduce federal healthcare expenditures by up to $880 billion over that time period, the bulk of which is likely to come from Medicaid because Trump declared Medicare off-limits.
At the same time Republican leaders insist that efforts to cut the healthcare program for people with low incomes, people with disabilities and older adults in nursing homes would not harm those “deserving” of help.
“Everybody is committed to preserving Medicaid benefits for those who desperately need it, who deserve it and qualify for it,” House Speaker Mike Johnson (R-La.) said after the House passed the first version of the fiscal 2025 budget resolution in February.
Yet limited real-word experience suggests that Medicaid work requirements don’t promote employment or save large sums of money, but do cause many enrollees to lose coverage, such as what happened in Arkansas in 2018 and 2019. The first Trump administration invited states to implement work requirements, but President Joe Biden adopted the opposite position and courts blocked many state programs.
Using work requirements as a way to save money may also prove difficult because the policy would apply to few people.
There were 26.1 million adults enrolled in Medicaid who do not receive disability benefits or qualify for Medicare as of March, according to an analysis of Centers for Medicare and Medicaid Services data published by the healthcare research institution KFF.
Of those, 44% work full-time, 20% work part-time, and 29% aren’t working because they are students, caring for a family member or are ill. The remaining 8% cite retirement, inability to find work or other reasons for not having a job.
That amounts to just over 2 million people nationwide who would be subject to work requirements under previous proposals and state programs, although many more would have to prove they are working.
Implementing work requirements that would disenroll people for noncompliance may actually make it harder for people to find and keep jobs, said Amaya Diana, a policy analyst at the KFF Program on Medicaid and the Uninsured. “Research does show that access to affordable health insurance and care promotes an individual’s ability to obtain and maintain employment,” she said.
Arkansas and Georgia
In Arkansas and Georgia, which is the only state with a type of work requirement in place, experience has shown that limiting access to Medicaid doesn’t eliminate the need for medical care, said Robin Rudowitz, director of the KFF Program on Medicaid and the Uninsured. The difference is that there’s no one to pay the bills when they get it, she said.
“If individuals lose insurance, if they still have healthcare needs — particularly emergency or acute needs — they are likely to still need to seek care. And then without insurance coverage, basically, there would either be uncompensated care for hospitals or uninsured patients for community health centers,” said Rudowitz, who visited Arkansas to research its since-shuttered program.
“The policies were pretty confusing for enrollees, and there were no indications of increases in employment,” Rudowitz said.
Some 18,000 people lost coverage in Arkansas during that time, including many who qualified but were unable to navigate the bureaucracy, before courts shut the effort down. Many people who should have been eligible got bumped purely over reporting issues, especially beneficiaries with chronic illnesses and other issues that made compliance difficult.
This isn’t stopping Arkansas from trying again. The state submitted a new Medicaid 1115 waiver request for work requirements to CMS eight days after Trump returned to the White House.
The work requirements in Georgia’s “Pathways to Coverage” program aren’t faring any better, said Joan Alker, executive director of the Georgetown University Center for Children and Families. Georgia’s waiver, which CMS approved during the first Trump administration, expires Sept. 30 and the state is seeking to renew it.
But while Georgia anticipated 100,000 participants in Pathways to Coverage, it reported this month that it has just 4,903. That meager enrollment is the product of spending heavily to have Deloitte Consulting build a verification system that Georgia hasn’t actually used to enforce work requirements, Alker said.
“The track record there is that it’s proved to be pathways to profit for Deloitte, but not pathways to coverage for Georgians,” Alker said. “Deloitte has gotten millions of dollars of contracts to set up complicated websites and reporting requirements.” The state has spent $86 million on the effort, with the bulk going to the consulting company, the investigative journalism outlet ProPublica reported in February.
Arkansas officials said they considered the problems from the first attempt when devising their new plan.
“We have worked to design this amendment taking into account lessons learned from previous work requirements,” Arkansas Medicaid Director Janet Mann said when Gov. Sarah Huckabee Sanders (R) announced the new work requirements proposal Jan. 28.
Without a new law explicitly authorizing Medicaid work requirements, states could again run into legal challenges. The Biden administration asserted that attaching work requirements to Medicaid is not permitted under statute and undermines Medicaid’s mission to provide health coverage. Many courts agreed.
Sanders said the amended plan would avoid that problem by leaving people enrolled, but suspending benefits for people who are not “on track” with community service, school or work requirements. These beneficiaries would be offered “success coaching” to stay enrolled and craft “personal development” plans allowing them to comply, Mann said.
Arkansas also contends it has addressed the bureaucratic and logistical obstacles to meeting the work requirement, Mann said. Rather than mandating that enrollees report their work hours, for instance, the state will use its own records, conduct audits and perform outreach, she said.
“We focused on the importance of providing clear communication through multiple means, simplicity in design and the need for personal interaction rather than the overreliance on technology,” Mann said.
Diana said it is too soon to assess whether the new version would perform better. “It would still be suspending benefits for individuals who do not meet these requirements, and there’s still potential issues for those who fell through the cracks in the first go-around — those with chronic conditions and so on,” she said.
Provider implications
Whether any of these pitfalls concern Capitol Hill Republicans and whether they have ideas about making the policy effective is unknown to the public. Congress has not held hearings on the issue, even though committees plan to draft the tax-and-spending-cuts package in early May. Johnson aims to complete work on the legislation by the Memorial Day break, which runs May 23 through June 2.
Beyond the potential loss of health coverage for millions, Alker said Congress should consider the impact on providers, which goes beyond uncompensated care.
Providers also would likely face difficult reporting requirements of their own, perhaps even having to certify whether a jobless patient is sufficiently disabled to continue getting coverage. “Those are going to require a doctor’s note,” Alker said.
This presents a moral hazard to healthcare providers, Alker said. “Their decision may result in their patient losing their health insurance, which creates very real opportunities for them to violate their ethical obligations to their patients,” she said.
Health insurance companies that administer Medicaid benefits also could confront fluctuating payments from states that set monthly outlays on a per-person basis. People cycling on and off the program would make revenue less certain. That, in turn, could hamper providers, Alker said.
“This could create a lot of havoc for providers and hospitals, both in terms of possibly losing payment retrospectively [and] creating enormous paperwork burdens,” Alker said.
Medicaid is a joint federal-state program and states carry out most administrative functions, so Congress may not specify exactly how work requirements would be designed.
Dedicating federal money to job assistance programs could help, Rudowitz said. The Congressional Budget Office reported in 2022 that work requirements paired with job supports could be more effective. But spending additional money on social programs runs counter to the GOP’s policy agenda.
“If the goal is to try to increase work and connect people with work programs, there are things that states can do, but of course, Medicaid does not really pay for any of the things that would be typically thought of as work supports,” Rudowitz said.
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Bill to send patients’ electronic records to insurers faces roadblocks
AMANDA D’AMBROSIO , Crain’s HP, 4/23
For years, hospitals have sent patients’ medical information to insurers via mail or fax to get approved for payments. A state lawmaker is trying to digitize the process.
Assemblyman John McDonald, an Albany representative and pharmacist, introduced legislation last week to require hospitals to send patients’ entire electronic health records to insurance companies to help them decide whether to cover specific services. The bill aims to reduce the administrative burdens insurers face during the prior authorization process, when health plans review a patient’s medical history to decide whether specific treatments and procedures are necessary before they pay for them.
“I see patients waiting days on end for prior approval,” McDonald said. “This helps accelerate the process.”
The bill has the backing of insurance companies and local businesses that want to reduce their health care costs. But it also sets up another battle between health care payers and hospitals, who fear that a bill requiring them to hand off patients’ electronic medical records to health plans will result in more claims denials.
“The national, for-profit insurance companies that dominate the New York health insurance market have a demonstrated track record of abusive behavior,” said Brian Conway, a spokesman for the lobbying group Greater New York Hospital Association. State data shows that insurers denied more than 25% of inpatient claims in 2023, he said, adding that companies already fail to pay for necessary services at alarmingly high rates.
“GNYHA members are therefore extremely wary of these corporate behemoths, including when deciding whether to grant them access to patient data like EMRs,” Conway said.
Insurers have balked at criticism from the industry, saying that providing electronic medical records would not require hospitals to send more data than they would be sending via mail or fax, according to Lev Ginsburg, a member of the Local Business Relief Coalition, which is backing the bill. The hospital association denied this claim, stating that there are limits on the scope of medical record requests for insurance companies conducting reviews.
Ginsburg, who is also the executive director of the New York State Conference of Blue Cross Blue Shield Plans, which lobbies on behalf of health plans, maintained that the bill modernizes the payment system for providers and patients, which will result in fewer delays and improved care.
“It is, in my mind, very low-hanging fruit,” he said.
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Odyssey House plans $51M renovation as part of conversion under new Medicaid waiver program
A major drug treatment center in East Harlem may soon undergo a rehab of its own as part of a conversion to a new residential model intended to make it easier for facilities to bill Medicaid for mental health services.
Odyssey House, a Lower Manhattan-based recovery provider, plans to renovate its entire 53,000-square foot facility in East Harlem serving people with drug and alcohol addiction with onsite residential programs. In the process, Odyssey House will transition the site’s 196 beds into a remodeled facility with the ability to bill Medicaid under a new waiver that is expected to unlock millions of dollars to substance use providers in the state.
While the residential services will remain intact, the project will address critical infrastructure needs in the aging building, which has water leakages and a weakening façade, according to a filing with the state Department of Health. All told, the renovations will cost over $51 million, including $40 million for construction and the rest going to furniture, equipment and other costs, according to the filing.
The project is part of the state’s move to transition mid-sized and large residential mental health and substance use programs to a fee-for-service model, which will help them to take advantage of a new Medicaid waiver that provides matching funds to mental health institutions.
Since it was enacted in 1965, Medicaid has excluded so-called institutions for mental diseases, or IMDs – hospitals, nursing homes and other facilities with more than 16 beds that primarily treat mental health and substance use conditions – from receiving federal funds. In January 2024, the Centers for Medicare and Medicaid authorized a new waiver, known as 1115 that helps pay for the social and economic factors impacting health, to allow the sites to access Medicaid matching funds. State lawmakers recently placed a 2026 sunset on the current framework, forcing all institutions to change their operating certificates to the new billing system.
The new beds will focus on stabilization, rehabilitation and reintegration for people with substance use disorders, while also maintaining the site’s existing federal-qualified health center.
As part of the project, the site, located on E. 121st St., will replace all windows and doors and re-mortar half of the building’s brick façade, according to the filing. A new air conditioning system and insulated roof will be installed, along with electrical, mechanical, plumbing and fire systems, two elevators and a rooftop generator.
Odyssey House estimates the new development will take two to three years. But despite the extensive construction needs, the changes fall within the current building ordinances, meaning it will not require any rezoning or building variances, a lengthy process that can hamper development projects.