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February 1, 2012
Jason Helgerson, Medicaid Director
John Ulberg, Medicaid CFO
Includes 25 MRT Phase II recommendations.
◦ Remaining workgroup recommendations will be
included in MRT waiver process.
No traditional cost containment items.
Budget is “cap neutral”
Provides two year appropriation and extends
super powers.
Preserves 4% annual spending growth.
Proposes State takeover of local administration
and county fiscal relief.
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All Other Medicaid
26% 18%
School Aid
Debt 23%
7%
State Annual % Growth
Operations/ -Medicaid (4.0%)
Fringe -School Aid (4.0% - school year basis)
Benefits -State Ops/Fringe Benefits (-0.4%)
26% -Debt (4.7%)
-All Other Local Assistance (2.7%)
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(dollars in billions)
2011-12 2012-13 2013-14
State Funds $21.1 $21.8 $22.8
-- DOH (Global Cap / 4% growth) 15.3 15.9 16.6
-- Other State Agencies 5.8 5.9 6.2
Federal Funds $24.5 $24.2 $26.1
Local Funds $8.6 $8.0 $8.5
All Funds $54.2 $54.0 $57.4
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Key Reforms
Program Streamlining & Basic Benefit Review
State/Local Responsibilities Workforce Flexibility and
Managed Long Term Care Change of Scope of
Implementation and Waiver Practice
Redesign Payment Reform and
Behavioral Health Reform Quality Measurement
Health Disparities Affordable Housing
Health Systems Redesign: Medical Malpractice
Brooklyn Reform
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(“-” denotes savings; dollars in millions)
2012-13 2012-13 2013-14 2013-14
Workgroup
Gross State Gross State
Basic Benefit Review $-30.3 $-15.2 $-35.7 $-17.9
Health Disparities $32.4 $6.1 $20.7 $0.3
Payment Reform $100.0 $50.0 $100.0 $50.0
Program Streamlining $25.0 $4.5 $40.0 $8.0
Workforce Flexibility/Managed LTC $1.5 $1.0 $1.5 $1.0
Spousal Refusal $-68.6 $-34.3 $-137.0 $-68.5
Redirect Transition II Funds $-25.0 $-12.5 $-25.0 $-12.5
Net MRT Phase II Recommendations $35.0 $-0.4 $-35.5 $-39.6
Affordable Housing ($75 million in base) and Health Systems Redesign/Brooklyn (fiscal impact
reflected in Payment Reform).
Net savings from phasing out growth in local Medicaid spending over three years is not included
above.
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Expanding coverage of podiatry services for adult
diabetics.
Providing breastfeeding support and tobacco
cessation counseling.
Reducing payments for elective cesarean sections
without medical indication.
Eliminating coverage for knee arthroscopy, back
pain treatments, angioplasty, and growth
hormones where there is no evidence of benefit.
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Expanding services to promote maternal and child
health, hepatitis C care and treatment, harm
reduction counseling and services, and language
accessible prescriptions.
Providing reimbursement for interpretation
services for patients with limited English and
communication services for patients who are deaf
and hard of hearing.
Implementing and expanding data collection to
measure disparities.
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Essential Community Provider Network
◦ Provides short term funding to address facility closure,
merger, integration or reconfiguration of services.
Vital Access Providers (VAP)
◦ Provides ongoing rate enhancements or other support
during significant restructuring.
HEAL reserves of up to $450 million to ensure
smooth transition of services within communities
and to provide reinvestment capital.
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Establishes Exchange as public benefits
corporation.
Nine member governing board.
Five regional advisory committees.
Thirteen policy studies.
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Establishment Establishment Establishment
Early Innovator Level One Level One (Dec) Level Two
Planning Grant Grant (June)
Awarded to NY selected Awarded to Applied TBD
NYS as one of 7 the NYS December 30,
Insurance states to build Department of 2011 to Requires
Department to information Health to continue the State
begin the systems to continue the planning Legislation
planning operate the planning process,
process ($1M) Health process and consumer Application
Insurance conduct policy assistance
Exchange studies activities, deadline:
($27.4M) ($10.7M) conduct policy June 29,
studies and 2012
support
Exchange IT
($48.5M)
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With Planning and Establishment Grant Funding
and Technical Assistance from the Robert Wood
Johnson Foundation, New York has a series of
Exchange activities underway:
◦ Simulation Modeling
◦ Business Operations Work Plan
◦ Five-Year Exchange Budget and Self-Sustainability Analysis
◦ Exchange Policy Studies
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Why is it the right time for the State to take
over responsibility for county Medicaid
program growth and administration?
1. Current 3% local Medicaid growth cap exceeds
2% Property Tax Cap.
2. MRT and Federal health care reforms require
greater administrative centralization to achieve
efficiency and effectiveness goals.
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Phase Down Growth Starting in 2013, Effective April 1, 2013
(in millions)
Fiscal Year Rest of State New York City Total
2012-13 $0.0 $0.0 $0.0
2013-14 $18.1 $43.1 $61.1
2014-15 $55.3 $131.8 $187.0
2015-16 $109.2 $260.4 $369.6
2016-17 $163.2 $389.0 $552.2
2017-18 $217.1 $517.7 $734.8
2018-19 $271.1 $646.3 $917.4
2019-20 $325.0 $774.9 $1,100.0
2020-21 $379.0 $903.6 $1,282.5
2021-22 $432.9 $1,032.2 $1,465.1
*Monroe County provides tax intercepts in lieu of Medicaid Cap payments. Monroe historical cap payments are
included for comparative purposes as a proxy for estimating local relief under this proposal.
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Federal Health Care Reform requires single point of
entry.
Enables fundamental rethinking/retooling of how
Medicaid program is managed.
Results: Services delivered more uniformly, efficiently,
and cost effectively.
State savings from capping administrative
reimbursement at FY 2012 levels partially offsets State
costs of takeover.
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($ in millions)
State Share 2012-13 2013-14 2014-15 2015-16
Cap Medicaid Admin at 2011-12 levels ($23.0) ($46.9) ($71.7) ($97.5)
Expansion of Enrollment Center $14.5 $29.0 $36.0 $36.0
State Staff $5.0 $9.0 $11.0 $11.0
FTEs 120 370 600 1,200
Subtotal – Medicaid Admin Takeover ($3.5) ($8.9) ($24.7) ($50.5)
Limiting MA Cap Growth (Phase Down) -- $61.1 $187.0 $369.6
Total – Financial Plan Impact ($3.5) $52.2 $162.3 $319.1
Additional Admin Savings (Efficiency) ($5.0) ($21.5) ($71.0) ($130.5)
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Work Ahead
New York is poised to fundamentally transform its Medicaid program
into a national model for cost-effective health care delivery.
New York is also well positioned to ensure that Medicaid reform also
means more comprehensive health system reform.
The Medicaid Redesign Team has developed a multi-year action
plan that if fully implemented will not only bend the state’s Medicaid
cost curve but also improve health outcomes for more than 5 million
New Yorkers.
To fully implement the MRT action plan, a ground-breaking new
Medicaid 1115 waiver will probably be necessary.
Still a lot of work to be done: It is up to the state, stakeholders and
the broader New York community to continue to work together to
successfully implement this multi-year action plan.
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MRT Website:
http://www.health.ny.gov/health_care/medicaid/redesign/
Sign up for email updates:
http://www.health.ny.gov/health_care/medicaid/redesign/l
istserv.htm
‘Like’ the MRT on Facebook:
http://www.facebook.com/NewYorkMRT
Follow the MRT on Twitter: @NewYorkMRT
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If you have questions from today’s presentation, please join us on
Twitter, Friday, February 3, 8:30 – 9:30 AM for an opportunity to ask
questions and have them answered in real time.
How to participate in the live Twitter chat:
◦ If you’re not already on Twitter, join at www.twitter.com
◦ Follow the MRT on Twitter: @NewYorkMRT
◦ Login to Twitter between 8:30 and 9:30 AM on Friday
◦ Ask questions by including #NYMRT in your tweets, or
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◦ You don’t have to tweet – you can watch the conversation just by
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