What's happening
This bill limits Medicaid optional services for adults to the minimum benefits required of private health insurance plans, excluding long-term care.
Why it matters
Reduces Medicaid coverage for adults (over 21) to only those optional services that are also required in the most basic private health insurance plans. meaning current Medicaid recipients may lose coverage for some services they previously received, such as dental, vision, podiatry, or certain therapies, if those are not mandated for private plans.
Could increase out-of-pocket health costs and unmet needs for low-income adults. , as Medicaid recipients may have to pay for or forgo services no longer covered, potentially worsening health disparities and shifting costs to other public systems (like emergency care).
Intended to address perceived fairness and state spending by aligning public benefits with private sector norms. , this change aims to reduce Medicaid costs and, by extension, property taxes, but may also discourage work for those who rely on Medicaid for essential services not covered by private insurance.
Excludes long-term care from the restrictions. , so individuals needing nursing home care or similar services would still have access, but other adult Medicaid recipients could see substantial benefit reductions.
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Headline styles
Limit Medicaid Optional Benefits
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Match Medicaid to Private Insurance
In Assembly Committee · Health · Sponsor Andrew Goodell
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2502
2019-2020 Regular Sessions
IN SENATE
January 25, 2019
Introduced by Sen. HELMING -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the social services law, in relation to aligning Medicaid optional services with private sector health benefits
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. This act shall be known and may be cited as the "Medicaid taxpayer equity act".
§ 2. The legislature hereby finds that it is fundamentally unfair to the taxpayers of the state for Medicaid optional services to exceed the minimum health insurance benefits levels that are required for private sector health insurance plans. Higher benefit levels for Medicaid compared to private insurance create a disincentive for people to leave public assistance and accept private employment and private health coverage. Higher Medicaid benefit levels are also a contributing factor causing the state to have the highest Medicaid costs in the nation and some of the highest property taxes in the nation. The purpose of this act is to ensure that Medicaid optional services for adults do not exceed the minimum health insurance benefit levels that apply to private insurance plans, other than long-term care services.
§ 3. Title 11 of article 5 of the social services law is amended by adding a new section 362 to read as follows:
§ 362. Benefits provided under this title for Medicaid optional services. The state shall not offer to individuals over the age of twenty-one years Medicaid optional services that exceed the minimum benefits required for health care plans under article forty-three of the insurance law. This section shall not apply to Medicaid long-term care services.
§ 4. The commissioner of the department of health shall submit to the federal department of health and human services for approval any amendments to the state plan required by this act. Furthermore, the commis-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04942-01-9
S. 2502 2
sioner of the department of health shall have the authority to promulgate or amend any regulations necessary for the implementation of this act.
§ 5. This act shall take effect on the one hundred twentieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law, in relation to aligning Medi- caid optional services with private sector health benefits
Purpose
The purpose of this bill is to facilitate the smooth transition from welfare dependency to self-sufficiency by requiring that adult Medicaid optional services be consistent with private sector health insurance coverage levels, as specified in Article 43 of the New York State Insur- ance Law. The bill does not apply to those under the age of 21 or to those receiving long term care services.
Summary of provisions
This bill would make the Medicaid optional services similar to the private sector health insurance coverage levels. This bill would not apply to those under the age of 21 or to those receiving long term services.
Justification
Under existing law, some of the Medicaid optional services exceed the health insurance coverage levels required for group plans under Article 43 of the Insurance Law. As a result, those on Medicaid receive a higher level of health coverage than most employees working in either the private sector or the public sector.
There are several important reasons highlighting the need to make Medi- caid benefit coverage consistent with the health insurance coverage generally available to employees in New York State. First, inconsistent Medicaid benefit levels trap people in welfare. Under current law, welfare recipients are discouraged from getting a private sector job because private insurance coverage is lower than Medicaid coverage. By making Medicaid coverage comparable to private sector coverage, welfare recipients will not lose health coverage when they accept a private sector job. Ensuring that Medicaid benefit levels are consistent with private health insurance coverage will facilitate the smooth transition from welfare dependency to self-sufficiency.
Second, it is fundamentally unfair to require taxpayers to fund optional Medicaid services that exceed their own insurance coverage. Welfare recipients should not have better health coverage than the taxpayers who the bill.
Third, Medicaid coverage consumes a substantial amount of both State taxes and local property taxes. Reducing the overall cost of this program would provide tremendous benefits to both State and local taxpayers.
Fourth, the high cost of Medicaid forces higher State and local taxes that hurt the business competitiveness of New York State, It is abso- lutely critical that New York State and local governments reduce their tax burden on local businesses so that these businesses can afford to grow and expand, add more jobs, and offer better wages and benefits to employees. One of our top priorities should be to help New York State become more competitive. The only way to accomplish that goal is to bring State and local spending in line with the rest of the nation. One of the largest categories of expense facing both the State and its coun- ties is the cost of Medicaid.
Prior legislative history
A.9384 of 2012: Referred to Health A.4894 of 2014: Held in Health A.5120 of 2016: Referred to Health S.517 of 2017-2018: Referred to Health/A.4508 Held in Health
Fiscal implications
According to 2012-2013 data of Optical and Dental spending, this legis- lation will save State and local governments 114 million dollars.
Effective date
120 days after it becomes law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.