Redesign, Reform, or Reductions…again? By Patricia Krasnausky, President & CEO of Cabrini Eldercare
As this is being written, the New York State Budget is being negotiated in Albany by our Legislature. This occurs every year at this time so it is not news. The news is that this year the process has been very different, especially as it pertains to Medicaid expenditures.
By Executive Order #5 Governor Cuomo appointed the Medicaid Redesign Team (MRT), a highly qualified team of professionals from insurance, healthcare, government, the legislature, the healthcare workers’ union (1199) and consumer advocates. He tasked them with reducing cost and increasing the quality and efficiency of the State’s Medicaid program for the 2011-12 fiscal year, meeting his budgeted Medicaid spending target, i.e. reducing Medicaid spending $982 million, “while avoiding across the board rate cuts to providers, institutions, individuals and communities.” Go to the official website for more information on the MRT: www.health.state.ny.us/health_care/medicaid/redesign/ .
Put briefly, the MRT gathered 4,057 suggestions which were narrowed down to 79 in less than two months. On February 24th, ahead of schedule, they were able to vote in favor of presenting them to the Governor. Now the 79 recommendations are in the hands of the Senate and Assembly with the April 1st Budget date looming.
Medicaid costs taxpayers an enormous amount of money for a variety of reasons: 4.7 million enrollees (increased due to the poor economy and job loss), generous benefits compared to other States, fraud and abuse, inefficiencies, and loopholes. Reform is needed. Redesign may be needed. The redesign recommended by the MRT is largely not fully developed, or fully understood at this time. Neither those who will require care nor those who will provide it can comprehend the full impact.
What is known is that although the task of the MRT was to reduce Medicaid spending “while avoiding across the board rate cuts to providers, institutions, individuals and communities,” a recommendation for a 2% across the board reduction in Medicaid payments is on the table for all providers of care. 2% doesn’t sound like much, but against a background of nine rounds of budget cuts since 2007 amounting in $1.5 billion in Medicaid payment cuts to nursing home and home care providers, it is staggering! The recommendations also eliminate the trend or inflation factor (which has already been eliminated for two years) while the cost of labor, supplies, and services continue to increase.
The Governor promises a budget by April 1st, and although we have advocated against some of the recommendations, there is little doubt that payments will be reduced once again. Continuing to cut services to elders and other special needs populations for whom Medicaid is the primary payor is neither redesign nor reform. It is simply more reductions impacting the most vulnerable and the providers that serve them: home care and day care agencies and nursing homes.
Patricia Krasnausky writes a monthly column in The Rivertown’s Enterprise Newspaper, a local paper in Southern Westchester County, as well as Town and Village, a local paper for New York City’s Lower East Side.
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