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DOH Offers Recorded Medicaid Budget Briefing

In lieu of a briefing on Medicaid savings proposals included in the Executive Budget, the Department of Health (DOH) has made available a recorded webinar that may be accessed on demand. The presentation slides, titled “2018-19 Executive Budget and Global Cap Update,” are available here. The link to the webinar recording is here.

The presentation, narrated by State Medicaid Director Jason Helgerson and Medicaid CFO John Ulberg, does not delve into the details of most of the individual Medicaid savings proposals included in the Executive Budget, but does provide a high-level overview of the issues driving Medicaid spending and impacting the Global Cap. Only the largest Managed Long Term Care (MLTC) savings provisions are itemized, and provider cuts are aggregated as "other provisions."

If the 2018-19 Executive Budget were enacted as proposed, Medicaid Global Cap state-share spending would reach $20.8 billion, an increase of $1.2 billion over the prior year that also includes $448 million in minimum wage funding. MLTC is the primary driver of increased spending, eclipsing pharmacy cost increases. While overall Medicaid enrollment has decreased slightly since April 2017, MLTC has added 21,000 members.

Medicaid savings figures are presented on a state-only basis, meaning that in most cases the financial impact that plans and providers would need to shoulder is twice the figure shown. The presentation makes clear that long term care is the largest single target for savings, although provisions related to the Essential Plan also feature a prominent role in achieving the $850 million all-funds savings target established for Medicaid. The Essential Plan, with an enrollment of approximately 700,000, is credited with helping to cut the state’s uninsured rate in half, to what is now under 5 percent.

Although a number of budget provisions seem aimed at curtailing MLTC enrollment, Mr. Helgerson indicated that DOH analysis suggests that those signing up for MLTC seem to be really disabled and suggested that the level of disability in the program has been increasing over the last few years. Nevertheless, DOH hopes that the proposals will result in a decrease in MLTC enrollment growth from the current 14 percent down closer to the projection of 5 percent.

Acknowledging the impact of demographic realities that LeadingAge NY has been spotlighting for a number of years, Mr. Helgerson said that "many of us have been concerned about the potential growth in long term care in Medicaid for a long time with the aging of the baby boom generation, and I have my suspicions we are really beginning now to see the full impact of that."

The presentation notes that continuing to shift reimbursement to value-based payment (VBP) is the state’s first priority and that providers who refuse to move into VBP arrangements won’t find DOH very receptive regarding assistance. Those with questions on the Global Cap or Medicaid budget provisions are invited to submit them to MRTUPDATES@health.ny.gov.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841