State Budget Update

April 9, 2024

Good evening,

Yesterday Governor Hochul signed another budget extender that keeps the trains running on time in terms of state operations until the 11th after which we expect yet another extender to move forward that would take us through next Monday, April 15 at 11:59 pm.

The delay does not preclude meaningful negotiations from happening  – it just means that many of the big ticket items have yet to be resolved including Housing, Medicaid and more.  Governor Hochul states she has been in serious conversation with CMS regarding the MCO Tax.  And on that front Senate Majority Leader Andrea Stewart Cousins appeared before reporters earlier today and declared that lawmakers are no longer counting on an MCO Tax deal that would produce revenue that can be applied to (at least) the first half of the SFY25 budget.  That means the information we shared with you last week about cuts being ‘back on the table’ (although they never really fell off) is still real.  In these situations, we have seen all kinds of ‘creativity’ including enacted budget provisions that don’t become effective until October or even January 1 rather than taking effect April 1.  The state can save in areas where it is planning to spend using this strategy.  That’s why we have to keep pushing on the 3.2% COLA.  We need to ensure: 1) it does not include a restriction as to how eligible providers can use it, and 2) it doesn’t wind up in the ‘let’s defer this until January 1, 2025’ column.

This problem also puts things like our OMIG Audit Reform deal in jeopardy since some of the provisions we are pushing for would (appropriately) reduce the amounts OMIG recoups from providers for errors that do not constitute fraud.   And that’s the problem — the state has been relying on OMIG audit recoupments from honest providers who have NOT been found to have engaged in Medicaid fraud to fill budget holes for too long and the problem is just growing worse.

I am reluctant to say anything about the Part AA Commercial Rate Mandate other than that we continue to talk to lawmakers and state agency folks about the urgent need for this reform, aware of the fact that the longer a budget deal is delayed the more opportunity there is for non-believers to find fault with the concept or the proposed language.  Let’s just say we remain vigilant and laser focused and leave it there.

We have had lots of conversations about the telehealth rate issue we wrote about this morning and we will continue to do so to protect what we have and to add FQHCs to the mix.

We are pushing for inclusion in any deals on an across the board rate increase although (as you will recall) the Governor’s budget proposal included a 3% across the board rate increase for DOH Programs only and the Senate included language in their one-house bill that specifically excludes Article 16, Article 31 and Article 32 providers (probably because lawmakers made the calculation that these Programs would be eligible for the COLA unlike most DoH Programs).  So, this one is uphill all the way.

That’s all for now.  Keep the faith and have a good night.