March 14, 2008

POST-KRISTEN MEDICAID REFORM?

New NYS governor should retain Spitzer health team, push for needed Medicaid reform; Wright to sponsor 30 percent rent cap bill
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Paterson should pick up on Medicaid reform

Disgraced Gov. Eliot Spitzer didn't serve long enough to leave much of a legacy, but one Spitzer initiative worth seeing through to the end is his fight for Medicaid reform. Fortunately, those who have worked with incoming Governor David Paterson from his days in the State Senate are pretty confident that when he takes office Monday, he will pursue Spitzer's efforts to get money out of the pockets of HMOs and pharmaceutical companies and into the hands of the front line community-based care providers that serve four million poor and disabled New Yorkers who rely on Medicaid and other public programs for survival.

Paterson said becoming governor during budget season is like being "the student who's getting ready for the final exam but they didn't attend any classes." One way he will be sure to ace the test is holding on to Spitzer's health team led by Deputy Secretary for Health and Human Services Dennis Whalen and Deputy Commissioner of the Office of Health Insurance Program and State Medicaid Director Deborah Bachrach. This group has a solid grasp on the right changes that need to be made.

"From the commissioner to the worker bees, Spitzer's health team has been incredible. It would be a shame if Paterson rocked the boat," said Lara Kassel, the advocacy coordinator of Medicaid Matters New York. But Kassel added that it doesn't seem as though Paterson will disrupt a good thing, and that he could possibly even improve the situation. "He doesn't have his own health agenda, and if anything he's more progressive and liberal than Spitzer."

In the one-house budget bills proposed Wednesday, the Assembly bill delays the implementation of the proposed Medicaid rate reforms that would shift funding from inpatient to outpatient care to January 1, 2009, and applies a four-year phase-in of the proposed changes to hospital detox rates (the executive budget would implement the changes to detox in one year). The Senate one-house budget, however, rejects the necessary rate reforms.

Both the Senate and the Assembly accept the proposed enhancements to primary care, like increased rates for community-based clinics, and increased rates to physicians providing services after-hours and on weekends. Both the Assembly and Senate also accept the proposal to expand Child Health Plus to 400 percent of the federal poverty level. The Assembly even takes the great step of reducing the premiums proposed in the budget.

When it comes to other issues affecting poor people and people with HIV/AIDS, Paterson's record is quite promising. Paterson, who will be the first African-American and legally blind governor, has been a strong support of LGBT issues, Rockefeller drug law reforms and HIV/AIDS issues. According to the Gay City News, he split with Gov. Spitzer in June and opposed forced testing for rape suspects, since a negative test result on an alleged rapist will not provide definitive information to a victim and the victim might not take immediate post-exposure-prophylaxis to prevent infection.

In other news…:

  • Assembly Member Keith Wright agreed to co-sponsor with Senator Tom Duane a bill to cap rents for poor people with AIDS receiving state rental assistance at 30 percent. Last year, the bill (A. 5473/ S. 2890), which passed in the Assembly but not in the Senate, was sponsored by Assembly Member Deborah Glick. She is now on the Education committee. HASA is the only rental assistance program in the state that doesn't cap recipient rent shares at 30 percent of income, allowing recipients to keep only $330/month, with the rest going to rent. (The nonsensical policy is a legacy of the Pataki administration.) That means HASA recipients must survive on $11 per day without the help available in supportive housing.
  • AIDS advocates are still pushing members of the Assembly and Senate to support Rep. Dick Gottfried's $4 million/year rate increase for COBRA case management, which provides essential psychosocial support to people living with HIV/AIDS. Studies have shown that case management is one of the two most important reasons people stay in consistent medical care (the other is housing). Nonetheless, COBRA rates haven't increased in a decade. Advocates say the rate increase could be cost neutral with reforms to the COBRA system and dozens of AIDS organizations are pushing for it. The rate increase is expected to be in the Assembly's one-house budget and the Senate should put it in theirs. The language was not in any of the one-house bills, but can still be added before the budgets are reconciled.
  • Contact your member in the state Assembly, and tell him or her to support cost neutral COBRA increases!



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