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2003-12-23 -- NY State Medicaid Plan Would Restrict Nursing Homes

The San Francisco Gray Panthers are having a meeting on the Medicaid
crisis and proposed Medicaid restructuring on Tuesday, January 20th,
from 1-3 PM at the First Unitarian Church, 1187 Franklin near Geary,
in San Francisco.  All are invited.


New York Times, December 23, 2003

New York State Medicaid Plan Would Restrict Nursing Homes to Truly
Poor


Leaders of the State Senate yesterday proposed far-reaching revisions
of Medicaid, the health plan for the poor that has become a crippling
burden on New York's state and local governments. They recommended,
among other things, the diversion of people from nursing homes and
restrictions on access to some prescription drugs.

The Senate Republicans said their plan would both improve care and
save $2.5 billion over five years, claims that were made difficult to
gauge by a lack of detail in their report. Democrats and a variety of
liberal groups quickly disputed such predictions, but some of the
Senate's usual critics, particularly advocates for the disabled, held
out cautious hope that this time, the Republicans were on to something
valuable.

Majority Leader Joseph L. Bruno and his colleagues are taking on the
$40 billion-a-year program because of the strain it puts on state
finances, and discontent at the local level that many state lawmakers
fear could grow into a political backlash against them. The counties
and New York City pay a share of the program's cost, an expense that
has expanded even as their budgets have contracted, prompting local
officials to complain that Medicaid has forced them to cut other
programs and raise taxes.

The Senate Republicans' plan includes a provision for the state to
take over local governments' payments for a fast-growing part of
Medicaid, Family Health Plus.

The Republicans argued yesterday that the annual ritual of nipping and
tucking Medicaid to try to limit its growth was inadequate, that what
was needed instead was a basic rethinking of the program - a stance
that, for the moment, positions them as leading a debate on the future
of the program. Whether the Democrats who control the Assembly - and
who are usually Medicaid's defenders - or Gov. George E. Pataki, a
Republican, will even take part in such a debate remains unclear.

In an interview yesterday, Mr. Pataki said only that he would review
the Senate's proposals, a position seconded by a spokesman for
Assembly Speaker Sheldon Silver. In the past, Mr. Pataki has been
irked when Senate Republicans have tried to set the legislative
agenda, rather than letting him do so.

The Senate report said, "The traditional approach of incremental
reforms will yield nothing except the certainty that things will never
change." The report was the product of months of work headed by
Senator Raymond A. Meier, from central New York, and Senator Kemp
Hannon, of Nassau County.

Mr. Hannon said yesterday, "Our major discovery was, there is no
guiding philosophy."

Politically, the diciest part of the report is a series of steps that
would make it harder for people above the poverty line to gain access
to Medicaid or would make them pay more for services. In particular,
it takes aim at the most expensive part of Medicaid, long-term nursing
care.

Long-term care in a nursing home is ruinously expensive, often more
than $100,000 per year in New York City, so people often transfer
assets to other family members, to become poor enough - at least on
paper - to qualify for Medicaid. Rules in New York allow a spouse to
maintain tens of thousands of dollars in assets and, in some cases, a
modest income that normally would disqualify Medicaid enrollment, and
still get Medicaid coverage of nursing home care.

The Senate proposal would restrict such practices - a position that
critics say means people would have to spend themselves into true
poverty to qualify for needed coverage.

The Senate plan would also reduce some benefits and increase premiums
under Family Health Plus, a program that nearly doubled in enrollment
in the last year. Family Health Plus allows people of modest incomes
who are not poor enough to qualify for traditional Medicaid to buy
insurance through Medicaid at low rates.

Other Senate proposals would step up the practice of requiring people
in various arms of Medicaid to enroll in health maintenance
organizations, move some children from Medicaid into the less-generous
Child Health Plus program and limit the drugs doctors can prescribe to
Medicaid patients when there are less costly alternatives.

None of the ideas are new, and most, by themselves, would qualify as
no more than tinkering with the vast Medicaid edifice. But taken
together, they amount to a broad attempt to scale back the most
expensive entitlement in a state known for its entitlements. New York
spends far more on Medicaid than any other state, and requires a
bigger contribution from local government than any other state, and
Medicaid costs are rising much faster than most government expenses.

Some Senate proposals are intended to allow more disabled people to
live outside nursing homes, by giving them more flexibility to use
Medicaid to pay for other kinds of care and assistance.

Advocates for the disabled have called for such a shift for years,
saying that it would not only give people greater freedom, it would
also save money.

"There's a tremendous bias toward institutionalization, so we're very
happy to see an emphasis on ending that," said Tracie A. Crandell, a
policy analyst at the Center for Disability Rights in Rochester. "I
can't say that we disagree with all of the recommendations, and with
others, there just aren't enough details to tell. But we anxiously
await whatever legislation comes out of this."

Still, a top Assembly Democrat said yesterday that the Senate
Republicans had produced nothing to back up their talk of fundamental
reform, and that no such reform was needed.

"The Senate Republican report keeps the Medicaid program about 99
percent intact, which reflects a bipartisan consensus that New York's
Medicaid program provides urgently needed health care and support for
our health care system," said Assemblyman Richard N. Gottfried of
Manhattan, chairman of the Assembly Health Committee.

A coalition of dozens of mostly liberal groups including Planned
Parenthood, the Federation of Protestant Welfare Agencies, Gay Men's
Health Crisis and the Coalition for the Homeless released a statement
calling the Senate's report "a flawed plan that will deny health care
to many needy New Yorkers, damage our health care system, and cost
more in the long term."

On the conservative side, E. J. McMahon, a senior fellow at the
Manhattan Institute, offered cautious praise. "What I find surprising
and encouraging is that they're willing to focus on programs for
people who aren't really poor, which in the past they wouldn't want to
touch," he said.