Health Access
Medicaid Updates
Check back here often to find important information regarding the Medicaid program in New York State, including monthly “Medicaid Update” newsletters.
January 2012 Medicaid Update Newsletter
December 2011 Medicaid Update Newsletter
November 2011 Medicaid Update Newsletter
Has your Medicaid provider denied you access to the medicine your doctor has prescribed? Information on how to register a complaint, initiate an appeal or a fair hearing is below.
Medicaid Managed Care Appeals Info
Medicaid Redesign Team (MRT)
The Medicaid Redesign Team (MRT) was created by Governor Cuomo in January 2011. The purpose of the MRT is to save money and improve quality outcomes in the Medicaid program. The MRT consists of up to 25 voting members from the health care provider, business, legislative and health insurance sectors. It also includes state officers and state employees. An MRT member list can be found here.
The 2011-12 state budget included 73 recommendations from Phase I of the MRT for savings of $2.2 billion in year one and $3.3 billion in year two. Among the enacted recommendations: bundling the Medicaid pharmacy benefit into managed care (effective October 1, 2011), elimination of a pharmacy prescriber prevails provision (eff. May 1, 2011), allow prior authorization for exempted drug classes (eff. October 1, 2011), expansion of populations entering Medicaid managed care over a three-year period (beginning July 1, 2011), establishment of Behavioral Health Organizations (operational before January 2012), establishment of Medicaid Health Homes (operational November 2011), global cap on Medicaid expenditures (effective April 1, 2011) and across the board Medicaid reductions (effective April 1, 2011).
Phase II began work over the summer. MRT ‘workgroups’ have been established and are designed to bring more stakeholders into the process and to make recommendations to the full MRT by December for consideration in the 2012-13 state budget. Workgroups currently meeting: Basic Benefit Review Work Group, Behavioral Health Reform Work Group, Health Disparities Work Group, Health Systems Redesign: Brooklyn Work Group, Managed Long Term Care Implementation and Waiver Redesign, Payment Reform and Quality Measure Work Group, Program Streamlining and State/Local Responsibilities. Three additional workgroups will begin meeting shortly: Supportive Housing, Workforce Flexibility and Medical Malpractice. Check our Community Advocacy Calendar for dates and locations of these meetings.
Detailed Summary of MRT Work Group Meeting: Behavioral Health Reform, 09/12/11
Detailed Summary of MRT Work Group Meeting: Basic Benefit Review, 09/14/11
Materials disseminated at MRT Work Group Meeting: Basic Benefit Review
Detailed Summary of the Full Meeting of the MRT, 10/05/11
Detailed Summary of MRT Basic Benefit Review Work Group Meeting, 10/19/11
Detailed Summary of MRT Full Meeting, 11/01/11
Work Group Recommendations at MRT Full Meeting, 11/01/11
Detailed Summary of Final Meeting of the Full Medicaid Redesign Team, 12/13/11 (linked and below)
The final meeting of the full Medicaid Redesign Team (MRT) was held today in Albany. In addition to a webcast, other meeting materials can be found here. The general purpose of today’s meeting was to accept the reports from the remaining work groups and outline the process for the transmittal of the final MRT recommendations to Governor Cuomo.
The meeting began with an update from State Medicaid Director Jason Helgerson on the status of Medicaid spending in relation to the global spending cap. Helgerson reported that Medicaid spending through the end of October squeaked in under the projected spending amount. Estimated spending had been at $9,265,558 but the actual spending was at $9,140,844-a difference of $124,714. Although spending was less than anticipated, Helgerson noted that the Department continues to closely watch the Medicaid enrollment numbers. Since April there has been a 2% increase in Medicaid enrollment and a 2.7% increase in Medicaid Managed Care enrollment. While the Department is monitoring the enrollment numbers Helgerson did note that the antiquated eligibility system in New York could be skewing the enrollment numbers. The formal report on Medicaid spending should be available on the Department’s website today.
The focus of the meeting then shifted to an overview of the process by which the MRT would share its recommendations with Governor Cuomo. It was reported that Department of Health staff have prepared a report that will be shared with the MRT members for review and feedback. This report will include a summary of Phase 1 MRT reforms and the approved recommendations of the MRT work groups. This report will be sent to the MRT membership on December 14th with the understanding that any feedback from MRT members must be received by December 20th. The final report will be sent to Governor Cuomo on December 31st.
Prior to the sharing of the work group reports there was a brief discussion among MRT members as to whether the workgroups would continue meeting after the report was sent to the Governor. There is no formal process in place by which the work groups will continue to meet. All parties agreed that this issue warrants further discussion.
The presentations of the four work groups were largely uneventful. Co-chairs for each work group gave presentations on their respective work group’s activities and final recommendations. The Basic Benefit Review work group presented first, followed by the Workforce Flexibility and Scope of Practice work group, the Payment Reform and Quality Measurement work group and the Affordable Housing work group. For the most part the recommendations of the work groups were accepted by MRT members with little controversy. However, there was a lively discussion regarding recommendations contained in the Basic Benefit Review work group’s presentation. The work group had proposed creating an evidence based system to review whether a benefit should be covered under Medicaid. Both Assembly member Gottfried and Senator Hannon expressed reservations about this concept. Ultimately it was agreed that the recommendation should reflect that any meetings regarding changing Medicaid benefits be open to the public and that the Legislature’s role in changing Medicaid benefits must be preserved.
Another notable exception to the approval of recommendations was Assemblyman Gottfried’s decision to abstain from voting on the Workforce Flexibility and Scope of Practice work group recommendations. Gottfried explained that the Assembly’s chair of the Higher Education Committee Deborah Glick had reservations about some of the proposals and that in deference to those concerns he would not be voting for the package. Additionally, a large number of people from the labor union DC 37 were in attendance to protest some of the MRT Phase I proposals relating to rolling certain benefits and populations into Medicaid Managed Care. In a departure from the MRT’s normal practice, Co-Chair Michael Dowling gave the group’s representatives a five minute time slot to speak to the larger group.
Before the close of the meeting, MRT member Stephen Berger made a motion that a recommendation in support of increased staffing for the Department of Health be included in the report to Governor Cuomo. The group agreed that increased staffing was critical to the success of many of the MRT initiatives.
Health Benefit Exchange
In accordance with President Obama’s Federal Health Care Reform initiatives, every state must set up a health benefit exchange, which is a transparent, centralized marketplace that provides access to more affordable, comprehensive health insurance coverage options to individuals and small businesses.
New York officials are currently engaged in the process of establishing the exchange and hold stakeholder meetings on varoius aspects of the exchange. Check back here frequently for updates on those meetings and general information on the health benefit exchange in New York.
2/16/12 Summary of Health Benefit Exchange Stakeholder Meeting
2/16/12 Health Benefit Exchange Stakeholder Meeting Materials
Partnership for Prescription Assistance (PPA)
With an 8% unemployment rate and more than 14% of New Yorkers remaining uninsured, according to the latest Gallup poll numbers, there are many New Yorkers who need help. The Partnership for Prescription Assistance matches uninsured and financially struggling people to patient assistance programs that provide free or nearly free medicine, and this free program has matched more than 230,000 New Yorkers with programs that may help.
Our mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. We offer a single point of access to more than 475 public and private programs, including nearly 200 offered by pharmaceutical companies. We have already helped millions of Americans who applied to patient assistance programs get free or reduced-cost prescription medicines.
There are other companies that offer to connect consumers to these same programs for a fee – some of which use our name without our permission. The Partnership for Prescription Assistance will help you find the program that’s right for you, free of charge. Remember, you will never be asked for money by a PPA Call Center representative, or on our web site.
PPA Bus Tours
Millions of Americans have been helped by public and private patient assistance programs, but millions more could benefit. That’s why the Partnership for Prescription Assistance launched the Help Is Here Express bus tour. Our rolling information centers are equipped with computer terminals and mobile telephones so patients can find out if they may be eligible for free or reduced-cost medicines while onboard.
Medicare Part D
New York has more than 3 million Medicare beneficiaries enrolled in Part D, and according to latest issue of JAMA, Part D is saving Medicare overall about $1,200 per year in hospital, nursing home and other costs for each senior who previously lacked comprehensive drug coverage. According to other experts, this translates to about $12 billion in annual savings across Medicare. Importantly, the research also found that Part D has fostered increased access and adherence to medicines among seniors.
Prescription Drugs
New York State Public Health Law requires the state to collect and publish the prices of the most commonly prescribed drugs at all participating Medicaid pharmacies. This list makes it easy for patients to compare prices before filling their prescriptions.
New York State Prescription Drug Price List
Disease Prevention
America’s research-based pharmaceutical companies are working actively in partnership with the U.S. Government and world health officials to make sure that patients have the vaccines and antiviral treatments they need to help prevent and treat the flu and avian flu.
Operational Framework for Partnering with Pharmacies for Administration of 2009 H1N1 Vaccine
World Health Organization recommendations for schools to reduce the impact of H1N1.
- February 25, 2012 – Snowshoe Softball Tournament
8:00 am, Capitol - February 25, 2012 – An Introduction to Drama Therapy
10:00 am, New York City - February 27, 2012 – Public Meeting on Vocational Rehabilitation and Supported Employment Services
10:00 am, Capitol - March 1, 2012 – The Little Purple Dress Luncheon
12:00 pm, Western - March 3, 2012 – Hope on the Slopes at Greek Peak Mountain Resort
9:00 am, Central