Authorizing the commissioner of health to apply for a medicaid reform demonstration waiver

A) a risk adjusted capitated managed care program that is separated into three components comprehensive care, catastrophic care, and an enhanced services component that will allow for flexible health spending accounts. Plans would also be encouraged to develop customized benefit packages targeted toward special needs populations. The commissioner may exclude specific Medicaid populations from the demonstration, and all other recipients would be given a choice of provider before being automatically assigned.

B) an opt out provision to allow Medicaid recipients to use their Medicaid premium to purchase health care coverage through an employer sponsored plan.

C) a choice counseling system to assist recipients in choosing a plan.

D) a system to monitor the provisions of health care services in the pilot program.

E) separate grievance resolution processes for Medicaid recipients and for Medicaid providers.

F) an advisory panel to advise the Department of Health on aspects of the demonstration. The department would comprehensively evaluate the demonstration for 24 months after the pilots have enrolled Medicaid recipients. Upon completion the commissioner may request statewide expansion to be approved by the legislature. Section two of the bill provides for an immediate effective date, provided the department is directed to submit a waiver within six months of the effective date.

Prior legislative history

2015 - S.3973/A.5986 - HEALTH/Health 2013-2014 - S.1438/A.5585 - HEALTH/Health 2011-2012 - S.3196-A/A.2280-A - HEALTH/Health 2010 - S.2639/A.6676 - HEALTH/Health 2007-2008 - S.679/A.3142 - HEALTH & SOCIAL SERVICES/Health 2006 - S.6860 - RULES/A.10177 - Health

Justification

Federal Medicaid waivers provide states with the flexibility they need to pilot new and innovative ways of delivering Medicaid services. New York State has a long history of establishing waiver programs that have improved the lives of those receiving care while at the same time saving taxpayers money. The Medicaid Reform Demonstration Waiver would follow in that tradition. It would create a consumer centered system that provides options for Medicaid recipients based on their particular health care needs. More particularly, it would provide the needed flexibility to use Medicaid funds to pay for employer sponsored health insurance where a recipient so chooses, to establish Health Savings Accounts, and to create plans for special needs populations that may benefit from services not traditionally covered by Medicaid. The demonstration would provide quality care at the most appropriate level and is expected to result in improved access, outcomes and consumer satisfaction while at the same time limiting the growth in Medicaid spending for taxpayers. This bill is closely modeled after a Medicaid waiver proposed in the state of Florida which was approved by the federal government in October 2005. New York State should follow Florida's lead and submit a waiver application to pilot fundamental change in the way New York State delivers Medicaid services. Applying a similar model under the unique characteristics of New York State will provide a broader understanding of the benefits of altering Medicaid delivery nationwide.

Fiscal implications

Given federal waivers require that the demonstration program be cost neutral, this bill would not have fiscal implications and may produce savings.

Effective date

This act shall take effect immediately, provided, however, that the Department of Health shall submit the Medicaid Reform Demonstration Waiver pursuant to the provisions of subdivision 6-b of section 366 of the Social Services Law, as added by section one of this act, within six months of the effective date of this act.