Medicaid is a critical healthcare program for low-income New Yorkers. Nearly 7 million residents, or over one-third of the state’s population, rely on Medicaid for healthcare coverage. The program provides health insurance to eligible children, pregnant women, parents, seniors, and people with disabilities. Medicaid is jointly funded by New York State and the federal government.

Recently, New York passed a controversial Medicaid reform plan that aims to cut $2.5 billion in Medicaid spending over the next year. While proponents argue the changes will control costs, make Medicaid more sustainable, and encourage more fiscal responsibility, critics worry the overhaul goes too far. They fear the eligibility changes, benefit cuts, and new costs imposed on enrollees will harm access to care and the health of vulnerable populations. There is uncertainty about how the changes will impact Medicaid enrollment and services. Opponents are challenging aspects of the overhaul in court. The reforms have prompted debate regarding the future of Medicaid in New York.

NY Medicaid Overhaul Passed

In March 2023, New York state lawmakers passed a massive overhaul of the state’s Medicaid program. This represented the first major changes to Medicaid eligibility and benefits in over a decade.

The overhaul made sweeping cuts and changes to Medicaid aimed at reducing costs and enrollment in the program. Key provisions included:

– Tightening eligibility requirements. This included increasing income thresholds, implementing an asset test, and removing the continuous coverage provision that allowed people to remain on Medicaid even if their income rose above the limit.

– Reducing benefits. Several optional benefits, such as dental, vision, and physical therapy for adults, were eliminated.

– Introducing copayments and premiums. Medicaid recipients will now be required to pay copays for services and monthly premiums based on income.

– Changing reimbursement for providers. Provider payment rates will be reduced across the board.

The Medicaid changes were passed quickly and signed into law by the Governor despite objections from healthcare advocates and legal threats. The overhaul represents a major shift for the Medicaid program in New York, which has historically provided generous benefits and eligibility.

Medicaid Eligibility Changes

The Medicaid overhaul includes several key changes to eligibility requirements that will impact who can receive Medicaid benefits in New York.

One major change is that the income threshold will be lowered from the current 138% of the federal poverty level down to 100% FPL. This means individuals earning above 100% FPL will no longer qualify, restricting Medicaid access.

In addition, new work requirements will be implemented. Most adult recipients who are not elderly or disabled will need to work at least 20 hours per week to maintain benefits. Requirements can be met through employment, job training, education, and other approved activities. Critics argue this creates barriers for low-income residents who may struggle with transportation, childcare, and other challenges.

The legislation also ends presumptive eligibility which had allowed people to access temporary Medicaid coverage while their full applications were pending. Applicants will now need to wait for applications to be fully processed before getting benefits.

Overall, the eligibility changes stand to reduce the number of New Yorkers covered by Medicaid. Groups likely to be impacted include unemployed and low-wage workers, college students, and those with fluctuating incomes. Tighter eligibility rules combined with work requirements will make it harder for vulnerable residents to qualify and retain health coverage.

Medicaid Benefits Cut

The Medicaid overhaul made significant cuts to benefits covered under the program. Some of the most impactful changes include:

– Elimination of non-emergency transportation. This provided rides to medical appointments for people without access to transportation. Without this benefit, many low-income individuals may miss doctor visits.

– Reduced prescription drug coverage. Certain brand name and non-generic drugs are no longer covered. This could make important medications unaffordable for some.

– No more dental and vision benefits for adults. Routine dental cleanings and vision exams are no longer covered. Poor dental health is linked to a number of medical conditions, so this change could lead to worse outcomes.

– Chiropractic care, acupuncture, infertility treatment removed from coverage. Limiting these benefits takes away access to alternative treatments that can improve quality of life.

– Physical and occupational therapy visits reduced. Medicaid recipients now have a 20 visit per year limit for these therapies. This reduction may negatively impact those rehabilitating from injury or illness.

The benefit cuts disproportionately affect the poor and vulnerable populations relying on Medicaid. Lack of transportation, prescription drugs, dental care, and rehabilitative services could result in serious health consequences. Patient advocates warn these changes will lead to worse health outcomes and higher medical costs over the long term.

Cost Sharing

The Medicaid overhaul introduces new cost-sharing requirements for some enrollees. Certain Medicaid members will now be required to pay monthly premiums based on their income level. There will also be copays for using the emergency room for non-emergency situations.

These new costs have raised concerns about affordability and access to care. Requiring premiums and copays could prevent lower-income individuals from seeking needed medical care. Healthcare advocates worry that even small out-of-pocket costs could be a barrier for Medicaid’s poorest members. There are also concerns that hospitals and clinics may see an increase in uncompensated care if patients cannot afford the new cost-sharing.

While proponents argue cost-sharing makes Medicaid more like private insurance, opponents say it undermines the core goal of Medicaid as a safety net. They claim mandatory premiums go against the program’s mission to provide healthcare coverage for those who cannot afford it. There are worries the changes could ultimately lead to loss of coverage if enrollees fail to make payments.

 Provider Payments – CDPAP & More

The Medicaid overhaul makes significant changes to how health care providers are reimbursed under the Medicaid program in New York. One of the most controversial aspects is reducing reimbursement rates for hospitals and nursing homes.

Under the previous Medicaid plan, hospitals were reimbursed based on the cost of care provided. The new law institutes a statewide base rate for all hospitals, regardless of location, services provided, or patient population served. This change aims to reduce overall Medicaid spending but has raised alarm among hospitals that disproportionately serve low-income Medicaid patients. Many warn the lower reimbursement could force service reductions or even closures.

Nursing homes also face lower reimbursement rates. The law cuts their rates by 1.5%, with further reductions possible in future years. Like hospitals, nursing homes warn the cuts could severely impact their financial stability and ability to provide quality care.

Beyond hospitals and nursing homes, the law enables the state to change reimbursement for physicians, clinics, and other providers. The concern is lower payments will lead fewer providers to accept Medicaid patients. This could restrict access to care if Medicaid patients struggle to find doctors and other providers willing to treat them at the lower reimbursement rates.

Advocates argue the state should be cautious about provider payment cuts to avoid restricted access or service reductions that ultimately harm Medicaid recipients. However, the state projects the changes will yield over $500 million in annual savings that can be reinvested in the program. The debate continues around how to balance cost control with ensuring adequate provider participation and patient access.

Enrollment Uncertainty

The Medicaid overhaul brings a high degree of uncertainty around enrollment numbers. Experts predict that the eligibility changes, benefit cuts, and new costs will lead to a significant drop in Medicaid participation.

Groups most at risk for losing coverage include low-income adults, people with disabilities, and seniors needing long-term care. Prior to the overhaul, low-income adults up to 138% of the poverty line qualified for Medicaid in New York. Now that threshold has been lowered to 100% of poverty, disqualifying many. Those with incomes between 100-138% will need to shop on the ACA exchanges and may struggle to afford premiums.

The cuts to benefits like dental, vision and physical therapy will also discourage some from enrolling. These services are important for maintaining health.

For seniors needing long-term care, the new asset test and look-back period will make it harder to qualify for Medicaid. This could force more people into spending down their assets to meet Medicaid eligibility.

Advocates worry that the cumulation of eligibility changes, benefit cuts and new costs will lead to a significant exodus from the Medicaid rolls. Time will tell how enrollment is impacted, but many vulnerable New Yorkers are likely to lose coverage.

Legal Challenges

Several lawsuits have been filed challenging aspects of the Medicaid overhaul. Opponents argue the changes violate federal Medicaid law and the Affordable Care Act by reducing eligibility and benefits.

Major lawsuits include:

– New York State Attorney General filed a lawsuit saying the work requirements violate federal law. The lawsuit argues Medicaid is meant to provide healthcare coverage, not to promote work.

– Disability advocacy groups sued saying the work requirements discriminate against people with disabilities. Many people with disabilities cannot work due to medical limitations.

– A lawsuit filed by healthcare providers and patients argues restricting benefits violates the intent of Medicaid to provide comprehensive coverage. They say benefits like dental care and physical therapy are medically necessary.

– Unions representing healthcare workers sued saying the cuts to provider payments will reduce access to care. They argue providers will opt out of Medicaid if payments are too low.

The legal arguments largely focus on whether the eligibility restrictions and benefit cuts undermine the core purpose of Medicaid established under federal law. The outcomes of these cases could determine if states can substantially overhaul Medicaid programs in ways that reduce eligibility and benefits.

Looking Ahead

There is uncertainty around what the future may hold for Medicaid in New York following this overhaul. Some predict there could be additional reforms and changes made in coming years as the state continues working to rein in costs.

Advocacy groups and healthcare organizations have called for the new policies to be reevaluated once implemented to assess their full impact. They want to ensure beneficiaries are not losing access to critical care and providers are not being put in difficult financial positions.

It’s likely the public debate will continue around how to balance controlling spending while still delivering healthcare services to low-income residents. Further reforms by the state are possible, particularly if the Medicaid budget remains strained even after this overhaul.

At the federal level, the Biden administration has signaled an openness to working with states on Medicaid waivers and new approaches. This could open the door for New York to propose additional changes in the future that require federal approval.

Overall, the future of Medicaid in New York remains uncertain. While major changes have been enacted, the full impacts are yet to be seen. It’s quite possible the public discourse, legal challenges and policy proposals around Medicaid will continue evolving in the coming years.

The Rough Road Ahead With Medicaid In New York

New York’s Medicaid program is facing major changes following the passage of a sweeping overhaul by the state legislature. While proponents argue the changes are necessary to control costs, critics worry they will restrict access to care for low-income residents.

The legislation makes several key adjustments to Medicaid eligibility, benefits, and provider payments. Work requirements, asset tests, and income limits will make it harder for some New Yorkers to qualify and stay on Medicaid. At the same time, benefits are being reduced, copays are increasing, and provider rates are being cut.

Advocates warn these changes could lead to hundreds of thousands losing coverage, disruptions in care, and increased financial strain on both patients and healthcare providers. However, state officials contend the reforms are crucial to ensure the long-term sustainability of Medicaid as costs continue rising.

The outlook for Medicaid in New York remains uncertain. Legal challenges to the new laws are likely, and it’s unknown how enrollment and provider participation may change. Much depends on how the state implements the complex reforms. For now, the Medicaid safety net in New York faces a period of transition as these major policy shifts take effect.