Medicaid panel finishes work, but obstacles remain in legislature

ALBANY — While divergent groups including hospitals and health care unions are backing a plan to overhaul New York’s $52 billion Medicaid program, it faces opposition from some patients-rights groups.

The Greater New York Hospital Association and 1199 Service Employees International Union, which traditionally have been at odds, both voted to approve the Medicaid Redesign Team’s recommendations Thursday. They later issued a joint statement, calling the proposed spending cap on Medicaid “groundbreaking” and saying the proposals would lower costs and improve quality in the health care program for 4.7 million low-income New Yorkers.

Gov. Andrew Cuomo, who appointed members of the panel, on Friday spoke highly of their work. Their plan would place a cap on Medicaid spending and reduce the program’s cost for 2011-12 by $2.3 billion.

“I believe this is a major positive for the budget because we’re not going to have the opposition from Greater New York and 1199, which historically has been the main opposition through this process,” the governor said on an Albany radio station Friday.

But a number of advocacy groups, such as the Rochester-based Center for Disability Rights and the Save Our Safety Net campaign, said they are not happy with the final product, which doesn’t include some of the recommendations they pushed for and has others they fought against. They said they were disappointed the panel voted on the package Thursday afternoon — hours after the recommendations were made public — rather than continue deliberations Friday as scheduled and vote Tuesday, the deadline for submitting a plan to Cuomo.

“We are really exasperated by the whole process. We don’t think this is the way policy and law should be made in New York state,” said Nisha Agarwal, director of the Health Justice Program at New York Lawyers for the Public Interest. The organization is a member of the Save our Safety Net campaign.

The campaign opposes a recommendation to give financial aid to hospitals that want to close, merge or restructure. That would disproportionately affect poor communities, Agarwal said.

“They don’t live in the communities that are likely to lose these hospitals,” she said of the Medicaid Redesign Team.

A proposal the group supported to allow Medicaid to reimburse for language assistance did make it into the final cut, Agarwal said.

Four of the Medicaid Redesign Team members who were present Thursday abstained, including Assembly Health Committee Chairman Richard Gottfried, D-Manhattan.

Gottfried said members had been told they would have an opportunity before the vote to make motions to strike a proposal in the package or add a proposal that had been evaluated by the team.

But he changed his position Friday, saying the report overall is positive.

“Despite the concern I voiced yesterday about the speed with which the MRT voted, I believe, on the whole, that the final report contains needed reforms that will place our Medicaid system on a path to long term fiscal sustainability while safeguarding quality health care for New Yorkers in need, the elderly and the disabled,” he said.

The governor said Friday that change is difficult, and it triggers reaction from anyone who will lose as a result.

“This is a major system that we’re changing. There are many vested interests who are vested in protecting the status quo,” he said.

Healthcare Association of New York State spokesman William Van Slyke described the process as “an imperfect but in the end effective method of generating the compromises that were necessary to move forward” and do so with the least amount of negative impact on the public as possible.

The governor’s administration will submit the plan to lawmakers as proposed budget legislation for the 2011-12 fiscal year, which starts April 1.

A spokesman for Senate Majority Leader Dean Skelos, R-Nassau County, and a statement from Assembly Speaker Sheldon Silver, D-Manhattan, said the leaders looked forward to reviewing the plan and passing an on-time budget.

But disability and consumer groups were less optimistic about the outcome.

Disability-rights groups offered a proposal that would save $1 billion over five years, but it wasn’t given serious consideration and wasn’t in the final plan, said Bruce Darling, president of the Center for Disability Rights. The recommendation from his group and the New York Association on Independent Living was to shift more people from institutional to community-based settings; transition to a consumer-directed model of care; and take advantage of federal health-reform funds for community-based programs.

“New York has an over-reliance on institutional models of care, which are very expensive and honestly inconsistent with people’s right to live in the community,” he said.

The New York Association of Psychiatric Rehabilitation Services and 40 other groups pushed against a proposal that would have folded into the managed-care system Medicaid recipients who need mental-health and substance-abuse treatment and have major physical-health problems. The groups were successful in keeping the proposal out of the plan.

The groups believe the proper way to treat this population is through managed-care behavioral-health organizations. A recommendation to do that is in the plan, said Harvey Rosenthal, the association’s executive director.

The association opposes, however, a proposal to restrict access to certain medications for people with psychiatric disabilities, AIDS/HIV and organ-transplant patients.