Optimistic In '08 About Extending Medicaid

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Faced with an estimated state budget gap of over $4 billion and the rocky political road Gov. Spitzer has been traveling of late, legislators in Albany are not exactly primed for sweeping policy changes by the executive —especially to the state’s massive Medicaid program.

But Medicaid Matters New York (MMNY), a statewide coalition of more than 125 health care advocacy organizations, thinks significant reforms to the state health care system can still be achieved. MMNY coordinator Denise Soffel, health policy coordinator at the National Center for Law and Economic Justice, unveiled her organization’s legislative agenda for 2008 and expressed hope for what could be accomplished in the coming year.

“It’s time to build on last year’s changes and improvements,” she said last week, referring to steps taken to protect Medicaid beneficiaries and simplify the application process. “They were significant, but they were only first steps in creating a people-first health care agenda.”

Over the course of an hour at a Welfare Reform Network meeting, Soffel detailed a number of policy recommendations intended to improve medical services and expand coverage under the Medicaid program, which provides health care for more than four million low-income New Yorkers at an annual cost of almost $50 billion. She seemed optimistic, citing the governor’s previous commitment to reform: “This is a Medicaid-friendly administration,” she said.

Chief among MMNY’s recommendations is a call to increase access to Medicaid by raising the income limits for adults and further simplifying the application and recertification processes. Soffel proposed a new cutoff at 250 percent of the federal poverty level, which is already the measure used by the State Children’s Health Insurance Program, and is more than twice the current income limit for single adults. Under such a plan, a single adult could make up to about $25,000 and still qualify for Medicaid, as opposed to the current $10,400 threshold.

To better streamline access to Medicaid, MMNY recommends eliminating the in-person interview requirement and the asset test, which Soffel called burdensome and unnecessary. “This is not what we would call a user-friendly process,” she said. And echoing a charge made recently by Legal Services for New York, MMNY says language translation services are inadequate and must be improved.

Finally, Soffel expressed concern at the state health care system’s continued preference for high-cost hospital services, rather than allocating more funding for community-based primary and long-term care alternatives. If Medicaid had consumers in mind, she said, money would “follow the people,” not the other way around.

There won’t be a full picture of what the coming year holds for Medicaid in New York until Spitzer's executive budget is released later this month. However, in his State of the State address last week, the governor proposed several significant changes to the health care system in New York and voiced a commitment to reform. “We need an affordable health care system available to all,” he said in the speech. Spitzer called on the state to fully fund the expansion of the Children’s Health Insurance Program and to adjust Medicaid reimbursement rates to encourage more preventive and primary care, among other initiatives.

Soffel expects cuts to certain Medicaid programs and services, such as funding for graduate medical education, charity care, and “bad debt” care (where patients were going to pay, but did not), but was confident that eligibility, enrollment and benefit levels would not be affected by the budget shortfall.

– Tram Whitehurst