Washington Should Act Now on New York's Request For Mandatory Medicaid Managed Care
Albany, August 7 -- The coming federal welfare reforms makes the need all the more imperative for the federal government to allow New York to institute a mandatory Medicaid managed care program and end the 17-month delay, State Health Commissioner Barbara A. DeBuono, M.D., said today.
"Since the end of June, when federal officials told us that we would receive terms and conditions of the waiver approval in a matter of days, our request has been caught in a political chokehold," Commissioner DeBuono said. "Enough already."
The effects of federal welfare reform on New York State are still being analyzed, but one consequence is clear: New York needs to save every penny it can on Medicaid costs, which are the highest in the nation by far. "Our program could save federal, state and local governments $1.5 billion over five years, and provide better community-based health care for the nearly 3 million Medicaid recipients who would be enrolled in managed care," Dr. DeBuono said.
Each month of delay affects not only savings in the State budget, but the bottom lines for New York City and all county budgets as well. In counties operating a Medicaid managed care program with voluntary enrollment, Medicaid recipients are receiving better health care at a lower cost. For many recipients, this is the first time they have had a family doctor providing regular primary and preventive care.
"Our Legislature passed a bill last month authorizing a mandatory program for the next four years, making it crystal clear to the federal government that New York is ready," the Commissioner said. "The President promised that states would be allowed flexibility in administering these programs. And still, New York cannot move forward because of federal roadblocks."
Because of the continuing federal delay, the Department of Health today acted on behalf of 31 upstate counties by petitioning the federal government for permission to mandate managed care for their 350,000 Medicaid recipients who receive Aid to Families with Dependent Children (AFDC). These counties have been part of the State's voluntary managed care program.
"Because HCFA has not acted on our broader waiver, this is the next best thing we can do for these counties," Dr. DeBuono said. "However, this would provide no guarantee of federal support for a managed health care program for New Yorkers on Home Relief. So this population is left in limbo." Federal regulations require HCFA to grant or deny this application within 90 days -- unlike the broader waiver application, which does not impose a deadline on HCFA.
In March 1995, the State Department of Health submitted a request to the federal Health Care Financing Administration (HCFA) for a waiver from certain federal regulations so that New York could institute a mandatory managed care program for the nearly 3 million Medicaid recipients who are not in long-term care programs. If granted, the waiver also would secure federal funding for medical assistance costs of the Home Relief population.
In the intervening months, the Department has provided reams of written material to answer HCFA's questions. "We answered HCFA's most recent request for data on March 20, 1996," Dr. DeBuono said. "Since then, we've been getting mixed messages. One week we get a call saying that the terms and conditions will be mailed to us the next day, and then the next call tells us not yet."
Two weeks ago, U.S. Sens. Alphonse D'Amato and Daniel Patrick Moynihan sent a letter to Donna Shalala, U.S. Secretary of Health and Human Services, seeking closure on the matter. "The support of our congressional delegation has been enormously helpful," Dr. DeBuono said. "At a minimum, HCFA should tell us exactly when we will receive terms and conditions of the waiver, so that we can negotiate final waiver approval and begin providing better health care at a lower cost to as many Medicaid recipients as possible."
8/7/96-97OPA Contact: Claudia Hutton, Director, Public Affairs (518) 474-7354
New York State Department of Health Posted 8/12/96