2020 budget priorities
- Focus on Medicaid Cost Drivers
- Rebase the Global Cap to Reflect Enrollment and Program Changes
- Ensure Regional Parity
- Continue Health System Transformation
Hospitals and health systems are achieving what was asked of them by the first MRT — reductions in preventable admissions and readmissions, improvements in quality and patient access, and investments in their communities and social determinants of health, all of which contribute to lower Medicaid costs — while operating on restrained reimbursements. The work of the 2020 MRT should be focused on those segments of healthcare that have failed to bend the cost curve, not hospitals.
We also urge that the Medicaid global cap be adjusted to accommodate policy decisions the Governor and Legislature have made in the past decade. Increased enrollment in Medicaid under the Affordable Care Act, increased minimum wage, additional home-based care options and efforts to better manage the care of aged and disabled populations are all worthy initiatives, but they all increase Medicaid expenditures. The global cap should accurately reflect programmatic changes that have occurred since the global cap was initiated.
$2.5 billion in cuts will be painful, whatever the outcome of the MRT’s deliberations. This pain should be shared, not disproportionally targeted at certain regions of the state. Last year’s Executive Budget proposal essentially eliminated indigent care pool funding for a very specific group of downstate hospitals, many of them on Long Island and in the Hudson Valley. While the proposal was not included in the final budget agreement, it set a dangerous precedent that we are concerned may be revisited this year. Hospitals in the suburban regions face the same burden of caring for Medicaid, uninsured and underinsured patients as do more rural and urban areas of the state — in fact, 28 percent of all visits to Suburban Hospital Alliance member institutions are paid by Medicaid.
The state has made great progress in recent years in transitioning from volume to value. Much of this work has been funded with federal dollars, the future of which is now uncertain. We urge the MRT and the Legislature to consider a transition plan for these initiatives in the 2020-21 budget, to ensure that the progress made in the last five years is sustained. Continued investments in facility modernization, community-based care, social determinants of health interventions, behavioral health and substance abuse treatment, and the healthcare workforce will pay off in more efficient, effective and convenient care in the future. Reasonable market rules for health plans and continued regulatory flexibility also contribute to a stable glide path.