Politico: Advocates for children seek answers on 1 percent Medicaid reduction


February 18, 2020

ALBANY — More than six weeks after the Cuomo administration quietly announced a 1 percent across-the-board reduction in Medicaid payments, children’s behavioral health advocates say they are still waiting to hear from the state exactly what services will be affected and how. Andrea Smyth, executive director of the New York State Coalition for Children’s Behavioral Health, said it remains unclear whether some services — specifically, health homes that serve children — will be subject to the reduction. “We were seeking clarification about health homes serving children being included, but we weren’t getting a straight answer,” Smyth said in an interview with POLITICO. “We were being told, ‘You have to wait for the guidance and look to the 2011 across-the-board cut and that will give you information about what we’re going to do this time.’ These services for children weren’t around in 2011. They are new services that are being brought up at the request of the Medicaid Redesign Team — the original one — to expand services for children with mental health problems.” S H A N N O N Y O U N G Children look out at homes Getty Images Department of Health spokesperson Erin Silk said in an email that guidance went “out to all sectors”on Dec. 31, with exemptions also outlined on the agency’s website, which notes it was “revised” in February 2020. Silk added that the reduction to Medicaid payments — up to $190.2 million in the state’s share — took effect on Jan. 1 as scheduled. Smyth, however, said that as of Feb. 14 she had “not seen an implementation guidance document on how the 1 percent across-the-board Medicaid reduction would be applied to any affected children’s services.” “Is my rate going to go down? Is the premium to the managed care plan going to go down? … That’s what I meant by a guidance document,” she said. Silk told POLITICO on Friday that “as for the child health homes, no decision has been made.” Smyth said that while language about the reduction — which was announced in the state register on Dec. 31 — was “very general,” officials had suggested behavioral health services would not be affected. She said that she and other members of the Campaign for Healthy Minds, Healthy Kids advocated in Albany in late January with the hope the cuts would not pertain to children’s behavioral health services. “My organization had an advocacy day on February 4 and that was the first time that we were told the draft guidance to implement the 1 percent … included health homes serving children,” Smyth said. “That was … after really a month-and-a-half of trying to get clarification.” Smyth said that while such a reduction would amount to about $500,000 to $700,000, the loss of those funds would be “devastating” to the 28,000 children receiving health home services. It could further delay care for the additional 145,000 children estimated to need such care, she said. “The slow uptake in growth on health homes serving children will be slowed even further, which will mean even fewer kids that need assistance getting care will get that assistance,” she said. “We’re not meeting expectations. This cut is going to make that situation worse.” Smyth said the Campaign for Healthy Minds, Healthy Kids — a coalition of behavioral health providers, advocates and families — is hoping for “clarification that health homes serving children will not be impacted.” It is also pushing for an immediate moratorium on all Medicaid reductions for children’s behavioral health services. Facing a $6 billion budget gap, driven primarily by Medicaid spending, the Department of Health issued a public notice of its request for federal approval of the 1 percent uniform reduction of all non-exempt Medicaid payments effective Jan. 1 to March 31, and each state fiscal year thereafter. Officials noted that certain Medicaid payments would be exempted from the reduction, including federally qualified health center services; certain disproportionate share payments to non-state- operated or -owned governmental hospitals; certified public expenditure payments to the NYC Health and Hospital Corporation; and services provided to inmates of local correctional facilities, among others. Health department spokesperson Jonah Bruno noted at the time that the reduction in spending growth “was approved by the Legislature as part of the FY 2020 Budget.”

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