On February 28, 2023, Dr. Talya Schwartz, President and CEO of MetroPlusHealth, New York City’s health plan for over 720,000 members, testified at the Joint Legislative Budget Hearing on Health in Albany.
Schwartz testified on behalf of The Coalition of New York State Public Health Plans and The New York State Coalition of Managed Long Term Care Plans, of which MetroPlusHealth is an active member. Schwartz used her time to highlight a few of the concerning budget proposals:
State’s Medicaid Managed Care and MLTC Quality Incentive Programs fund critical investments in provider quality and community-based initiatives that improve health outcomes and address social care needs for the State’s most vulnerable populations. For example, MetroPlusHealth has a dedicated housing unit that has supported members experiencing homelessness through the entire process of identification, application and placement in supportive housing and ongoing support to ensure members remain successfully in their new homes. Despite the positive impact and significant value, the Quality funding has been consistently reduced over time and is now at risk of full elimination.
The coalition urges the Legislature to reject this step backward and support Senate Bill 3146, which would codify the Quality Incentive Programs into law and ensure sustainable funding for what has become a powerful tool for driving high-quality and high-value care for lowest-income residents.
Removing the Pharmacy benefit from Medicaid managed care will harm Medicaid members, leading to massive confusion, gaps in medication access and adherence, and fewer services from community-based safety net providers.
Further, along with other stakeholders, Coalition plans have significant concerns about the State’s ability to operationalize the carve-out smoothly. It is slated to launch the same day as the restart of re-determining Medicaid, CHP, and EP eligibility for upwards of nine million New Yorkers. MetroPlusHealth alone is looking at approximately 50,000 redeterminations a month. The coalition urges the Legislature to repeal the pharmacy carve-out, protect enrollees’ access to needed medication, and protect the sustainability of safety net providers.
The Executive Budget includes a highly disruptive proposal that substantially upends MLTC coverage for elderly or disabled New Yorkers. The proposal, which would require MLTC plans to meet minimum enrollment thresholds and give the Health Commissioner “sole discretion” to trigger a plan procurement, would winnow the market down to just the largest MLTC plans—eliminating smaller, provider-sponsored, nonprofit, community-based plans and reducing choice for enrollees. Moreover, this proposal could effectively end local and regional MLTC plans upstate. The coalition urges the Legislature to protect the MLTC program and reject the proposed MLTC reforms.
The Coalitions applaud proposals to extend Essential Plan-like coverage to individuals with incomes up to 250% FPL and pregnant individuals and their newborns, among others. The coalition urges the Legislature to support expansions of coverage that help advance the goal of universal health care coverage in New York.
Watch the hearing.