2012-13 Enacted Budget MRT Phase II Proposals

MRT Phase II Proposals

  • Presentation is also available in Portable Document Format

April 3, 2012
Jason Helgerson, Medicaid Director
John Ulberg, Medicaid CFO

2012-13 Enacted Budget Highlights

Major MRT reforms endorsed by the Legislature:

  • Includes 24 MRT Phase II recommendations.
  • Global Cap: Provides two year appropriation and extends Medicaid Savings Allocation Plan (super powers) through March 2014.
    • Budget is cap "neutral" within 4% annual spending growth.
  • Medicaid Growth Takeover: State assumption of local Medicaid growth and administration.
  • Implementation of supportive housing initiative (slight delay saves $15 million).

Total Medicaid Spending

(dollars in millions)
  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

Note: Amounts reflect the Executive Budget projections. Changes reflecting the closeout of SFY 11-12 and legislative impacts on SFYs 12-13 and 13 -14 will be available in mid-April.

MRT Phase 2

Key Reforms

MRT Phase II Recommendations

Workgroup 2012-13
Gross		 2012-13
State		 2013-14
Gross		 2013-14
State
Basic Benefit Review -$38.8 -$19.4 -$38.8 -$19.4
Health Disparities $12.2 $6.1 $0.6 $0.3
Payment Reform $86.4 $43.2 $100.0 $50.0
Program Streamlining $22.0 $3.0 $40.0 $8.0
Workforce Flexibility/Managed LTC $1.5 $1.0 $1.5 $1.0
Legislative Adds (Prescriber Prevails and Estate Recovery) $11.4 $5.7 $30.4 $15.2
Redirect Transition II Funds -$25.0 -$12.5 -$25.0 -$12.5
Delay Supportive Housing -$15.0 -$15.0 $0.0 $0.0
Technical Avail (UPL Adjustment) -$25.0 -$12.5 -$25.0 -$12.5
Net MRT Phase II Recommendations $29.7 -$0.4 $83.7 $30.1
  • 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.

Basic Benefit Review Recommendations

  • Expanding coverage of podiatry services for adult diabetics.
  • Providing breastfeeding support.
  • 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.

Health Disparities Recommendations

  • 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.

Payment Reform Recommendations

  • 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.

Providing Relief for Local Medicaid Growth

  • Counties and New York City will save over $1.2 billion over 5 years beginning April 2013
all funds

Medicaid Administration

  • Commissioner of Health has authority to phase-in administrative functions to the Department by 2018
    • County employees will be able to voluntarily transfer to state positions based on their training and experience.
    • The transition of functions may be accomplished through the use of department staff and contracted entities, including contracts with local districts.
  • Non-Federal Medicaid administration reimbursement will be capped at 2011-12 levels
    • Up to $23 million pool may available for counties that exceed 11-12 levels.
  • State savings from capping administrative reimbursement at FY 2012 levels partially offsets State costs of assuming functions.

2012-13 Enacted Budget Highlights

New initiatives agreed to by the Legislature

  • Prescriber prevails for mental health drugs within managed care.
  • EPIC coverage reinstituted for Medicare Part D plan co-payments or co-insurance ($30.6m in 12- 13 and $36.3m in 13-14).
    • Eligible seniors must be enrolled in a Medicare Part D drug plan and have incomes below $35,000 (singles) or $50,000 (married).

Initiatives not endorsed by the Legislature

  • Remove spousal refusal initiative.
  • Eliminate temporary operators language.
  • Restore estate recovery.
  • Eliminate expansion of tobacco cessation counseling to include dentists.

Conclusion

Additional Information

20112-13 Enacted Budget: Questions?

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MRT: Additional Information