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NY Daily News Op-Ed: A Hit to Safety-Net Health-Care Providers We Must Prevent

New York Daily News, December 14, 2020

By Richard N. Gottfried, Brad Hoylman, Gustavo Rivera and Linda B. Rosenthal

Many of New York’s health-care providers are in crisis. COVID-19 has increased the cost of providing care and cut their income because people are postponing care. This is on top of the fact that many health-care providers that rely on Medicaid have been on painful austerity budgets for years due to government cuts. Then, in April, Gov. Cuomo’s state budget slashed Medicaid even more.

As if that was not enough, one little-noticed action in the budget changes how Medicaid pays for prescription drugs. It will financially cripple our most vulnerable safety net providers and leave their patients without care.

Here’s the story. The vast majority of Medicaid recipients are required to get their coverage, including prescription drugs, from a Medicaid managed care plan. Each managed care plan does its own price negotiating with drug manufacturers. A small number get their Medicaid coverage directly from the state, without a managed care plan, and the state pays directly for their drugs, through its “preferred drug program.”

This year’s state budget “carves out” all prescription drugs from Medicaid managed care coverage and requires all Medicaid patients to get their prescription drugs directly through the state.

Like many small business owners, local baker and trained chef Samantha Hamilton had to figure out how to keep her home-based business, The Sugar Shack Bakery, alive during a…

In many ways, this is a good idea. The state will be negotiating drug prices for a much bigger group of patients than any one managed care plan. This will mean lower prices. And the preferred drug program gives patients and their doctors more choice of drugs than managed care plans do. For years, we’ve advocated getting Medicaid managed care plans out of the picture for drugs. (The NY Health Act, our single-payer bill, would get all insurance companies out of the whole picture for all of us, but that’s for another article.)

However, there is a serious problem in this plan. Community health centers, HIV providers, sexual health clinics, many rural hospitals and other safety net providers currently participate in a federal program called 340B, which allows them to purchase prescription drugs at a significantly reduced price. These providers rely on their 340B savings to “stretch” their Medicaid funding to pay for health care for the people they serve. The catch is, under federal law, this only works for drugs purchased under Medicaid managed care.

340B was created in 1992 by Congress “to stretch scarce…resources as far as possible, reaching more eligible patients and providing more comprehensive services.” It guarantees dramatically lower drug prices for the providers that are covered. In New York, these providers are all non-profit groups.

The money trail is complicated (like almost everything involving prescription drugs), but the bottom line is: If New York State shifts Medicaid drug coverage away from managed care, the way it was done in the budget, these non-profit safety-net providers will lose hundreds of millions of dollars they now use for patient care.

If this change goes ahead, the state and the federal government will pocket the savings. The benefit will no longer help the safety net providers the 340B program was created to help. How the Cuomo administration will use the money is anybody’s guess.

We believe it’s possible to change the new carve-out law to protect the 340B providers and HIV health plans. But it will take time for the Health Department, legislators, health-care providers and HIV plans to develop, evaluate and implement a successful carve-out that does not diminish access and quality for programs and the vulnerable people they serve.

That is why we’ve introduced a bill to have the carve-out go ahead for the bulk of Medicaid, but to delay it for three years specifically for 340B providers. The Legislature and the governor have to pass this bill before the full carve-out goes into effect on April 1, 2021. Otherwise, vulnerable health-care providers that serve vulnerable New Yorkers will suffer serious financial harm, and many will not survive.

Gottfried, chair of the Assembly Health Committee, represents parts of the West Side and Midtown Manhattan. Rivera, chair of the state Senate Committee on Health, represents parts of the Northwest Bronx. Hoylman represents parts of Manhattan in the state Senate. Rosenthal, chair of the Assembly Committee on Alcoholism and Drug Abuse, represents the Upper West Side and parts of Hell’s Kitchen.

NY Post: Cuomo panel recommends $400M in hospital cuts as coronavirus pandemic rages

It’s unclear whether the Legislature or even the governor, who must approve the changes as part of the state budget, have the stomach to cut spending to medical facilities grappling with an expected wave of COVID-19 patients and a potential health catastrophe, as well as rolling back Medicaid services to patients.

“It’s never a good time to cut health care, especially when the only rationale is to fit into an artificial limit. It’s even more wrong in the midst of a growing epidemic,” said Assembly Health Committee Chairman Richard Gottfried (D-Manhattan).

Press release: Protecting Maternal Health

(Albany, NY) State Senator Gustavo Rivera, Assembly Member Richard Gottfried, advocates, and health care provider associations gathered today to call on the Legislature to pass the “Beyond the Fourth Trimester” bill, S.7147-A/A.9156 which would extend postpartum coverage for mothers from 60 days to one year after giving birth. The bill recently passed both houses’ Health Committees and has the support of physicians, midwives, hospitals, and advocates for improving reproductive health and reducing health care racial disparities.

City & State: Cuomo allies are aplenty on the Medicaid Redesign Team

Assemblyman Richard Gottfried and state Sen. Gustavo Rivera, who lead the health committees in the state Legislature, both expressed disappointment that NYC Health + Hospitals, the city’s public hospitals system, was left out especially given that New York City is expected to be hit particularly hard under the governor’s proposal to shift Medicaid costs onto localities. 

“As they say, ‘if you’re not at the table, you’re on the menu,’” Gottried said in a statement. A week earlier, he and Rivera had criticized the governor and his administration for not providing updates about the selection for the team.

January Community Update

Several new laws – on birth certificates, cash bail, “pre-registering” to vote, farmworkers’ rights, and boating safety, among others – are taking effect beginning in 2020.

And an increase in the minimum wage began on December 31, with hourly minimums rising to $15 an hour in New York City, $13 on Long Island and in Westchester County, and $11.80 in the rest of the state.

Daily News: ‘Nothing more than political theater’: Lawmakers raise doubts about Cuomo’s $6 billion Medicaid budget gap

ALBANY — Skeptical lawmakers skewered state health officials Wednesday as they sought details on Gov. Cuomo’s plan to tackle New York’s projected $6 billion Medicaid-induced budget deficit.

“It is a little bit concerning, scratch that, a lot, very concerning that you are coming to a public hearing on Jan. 29 and you’re telling us that by April 1 we have to just accept something that’s put together by a magical crew of folks,” Sen. Gustavo Rivera (D-Bronx), the chairman of his chamber’s health committee, said as he peppered state Health Department commissioner Howard Zucker and state Medicaid Director Donna Frescatore with questions about the proposal.

WSKG: Tensions Surface At Hearing On Proposed Cuts In Medicaid

ALBANY, NY (WSKG) – A lack of information on how Governor Andrew Cuomo plans to cut billions out of state-funded health care programs led to some tense moments at a legislative budget hearing Wednesday.

Cuomo, in his budget address, said he will convene a commission to decide how to cut $2.5 billion in Medicaid spending to help close a $6 billion budget gap without harming recipients.

But that commission, known as the Medicaid Redesign Team, won’t report back until sometime in March, potentially just weeks or even days before the state budget is due, leaving the Legislature little time to analyze the proposals.

Buffalo News: The Medicaid muddle: Cuomo’s budget proposal creates worry and confusion

Cuomo said the MRT panel should hold counties “harmless” in its plan and that Medicaid recipients should not see benefits affected. What’s that leave? Real cuts to providers? Tax hikes on private insurance plans? New ways to reduce waste or fraud?

“I’m incredibly concerned that the governor’s office has yet to release the necessary details we need to assess the potential impact on our localities’ Medicaid share,” said Sen. Gustavo Rivera, a Bronx Democrat who heads the Senate health committee. He said Cuomo’s fiscal overview suggests New York City – and “particularly residents of my district” – will feel end up seeing actual Medicaid cuts.

Gottfried, the Manhattan lawmaker, is even more pointed. “It’s hard to believe that it isn’t a sham,’’ he said of the MRT route. He thinks it’s quite possible Cuomo’s budget team already has specific plans that will be rubber stamped by the MRT. Gottfried served on the 2011 MRT, and he eventually praised the end product.

Bloomberg Law: New York’s Medicaid Budget Is Bleeding; Some Want Cash Infusion

The governor, in his Jan. 8 address, called the current situation “unsustainable” and referenced the state’s Medicaid Redesign Team, or MRT, which he created in 2011.

Assembly Health Committee Chairman Richard N. Gottfried (D) called the MRT largely a “sham.”

Many of the problems the state is experiencing came from changes made by the redesign, like moving toward managed care plans, he said. “I believe that the only responsible answer to this increase in Medicaid spending is on the tax side of the ledger.”

December Community Update

New Laws Take Effect in 2020

           Several new laws – on birth certificates, cash bail, “pre-registering” to vote, farmworkers’ rights, and boating safety, among others – are taking effect beginning in 2020. 

            And an increase in the minimum wage began on December 31, with hourly minimums rising to $15 an hour in New York City, $13 on Long Island and in Westchester County, and $11.80 in the rest of the state.

            I was proud to have been an Assembly cosponsor of a bill (sponsored by Assembly Member David Weprin and Senator Andrew Lanza) that allows persons who were adopted unrestricted access to their birth certificates once they turn eighteen.  Previously, adoptees could only get access by petitioning a court, and even then only with the consent of both biological parents.  The law, which was strongly supported by many adoptees seeking potentially life-saving information on their family medical history, takes effect on January 15.

DEFENDING CRIMINAL JUSTICE REFORMS: On Dec. 10, I joined advocates and elected officials to defend pre-sentencing reforms like eliminating the cash bail requirement for most non-violent crimes.

DEFENDING CRIMINAL JUSTICE REFORMS: On Dec. 10, I joined advocates and elected officials to defend pre-sentencing reforms like eliminating the cash bail requirement for most non-violent crimes.

            Important changes are also taking place affecting cash bail and streamlining pre-trial procedure.  Beginning on January 1, persons charged with most misdemeanors and Class E felonies will no longer be released from jail while awaiting trial, which will help end the criminalization of poverty that imprisons those not yet convicted simply because they can’t afford bail. 

            Several reforms to speed up trials and streamline the discovery process also took effect on January 1.

            Also taking effect on January 1 was a new law allowing 16- and 17-year-olds to “pre-register” to vote by completing a voter registration form that will make them automatically eligible to vote once they turn 18, making New York the 14th state to allowing pre-registration for persons beginning at age 16.

            Farmworkers have more rights under Farm Labor Fair Practices Act that took effect on January 1, aligning them with those already guaranteed other workers in New York: an eight-hour workday, with one mandatory rest day each week for farmworkers, as well as overtime pay set at time and a half.  The law makes it illegal for an employer to “lock out” farm workers over pay disputes or for seeking to unionize.

            Starting January 1, New Yorkers born in 1993 or later will now be required to take a safety course before operating a motorboat or jet ski.  “Brianna’s Law” – named after Brianna Lieneck, an 11-year-old killed in a boat crash off Long Island in 2005 – will require every motor boat or jet ski operator to take a course and obtain a boating safety license before operating a motorized vessel on New York waterways, by expanding the age group every year until all motorboat or jet ski operators are included in 2025.

Five Tin Pan Alley Buildings Are Designated Landmarks

            In a big win for the local community and for preservationists, on December 10 the New York City Landmarks Preservation Commission (LPC) voted to designate five buildings in New York City’s fabled Tin Pan Alley as New York City landmarks. We had been fighting for years to get Tin Pan Alley, the block of West 28th Street between Broadway and Sixth Avenue, designated. It became famous

in the late 1800s for its association with American popular music.  Dozens of music publishers and songwriters, including Duke Ellington, George Gershwin, Irving Berlin, and Cole Porter worked out of offices in a row of Italianate townhouses on 28th Street, writing classic songs like “God Bless America” and “Take Me Out to the Ballgame.”

            The most recent testimony I wrote in 2019 and submitted to the LPC along with New York City Council Speaker Corey Johnson urging it to designate five buildings in Tin Pan Alley as landmarks: 47, 49, 51, 53 and 55 West 28th Street.  The LPC’s action in December is the culmination of a long and hard-fought battle to preserve this vital piece of New York’s, and America’s, history.  

Public Finance Commission Issues Recommendations

            New York badly needs to combat the impact that big-money interests exert on State government – and I’ve been fighting to change the system.  It’s not a new cause for

me – I wrote New York’s first bill on public campaign financing. 

            To help address mega-donors’ out-sized influence on New York’s government, the Governor and legislative leaders agreed that New York State needed to create and implement a small-donor matching system for elections for State offices.  By matching small donations with public funding,  voices of all New Yorkers are strengthened instead of being overwhelmed by well-heeled special interests.

            Unfortunately, the Legislature and the Governor did not come to agreement on a campaign finance reform program before the end of the legislative session in June.  Instead, we created a “Public Financing Commission” charged with approving a campaign finance reform package by December, with Governor Cuomo promising that it would establish a campaign finance system that would serve as a “model for the nation.”  The recommendations it issued at the end of November will become law unless the Legislature amends or repeals them.

            The commission process was highly questionable, with its members apparently getting side-tracked by questions like whether to bar “fusion voting,” which allows different political parties in New York to endorse the same candidate; and whether to raise increase how many votes a “third party” would need to receive in order to be legally recognized with an official ballot line.

            Though the Commission did not act to eliminate fusion voting outright, as has been feared, it did move to increase the threshold for parties to obtain a position on the ballot, which puts their long-term survival in jeopardy.  Up until now, “third” parties like the Working Families Party and Conservative Party had to receive 50,000 votes in a gubernatorial election to maintain a ballot line and thus field candidates in a range of elections across the state on that ballot line over the course of the next four years. Under the Commission’s rules, instead of qualifying in every four-year gubernatorial election, parties will have to receive 2% of all votes cast or 130,000 votes, whichever is higher, for either governor or president, meaning that parties would have to requalify every two years with a significantly higher number of votes than are currently required of them every four years.  (No other state in the country that allows fusion voting requires “third” parties to qualify during presidential election years.) 

            The question of party qualification should have never been a part of this commission. Third parties are an essential part of the electoral system in New York, shining light on important issues that otherwise may not get the attention they deserve.  The proposed thresholds for party qualification are unacceptable.  We should be making it easier for third parties to make it on the ballot, not harder.

            That’s why I have introduced legislation to undo the recommendations of the Public Campaign Finance Commission relating to “third” parties.  My bill would restore the provisions of the Election Law relating to third parties.

            I will be working with other legislators to fix the problems created by the Commis-

sion’s set of recommendations, ensure the

viability of smaller political parties, and make the proposed matching campaign finance system for New York State even stronger.

Looming State Budget Shortfall Threatens Medicaid Funding

            New York’s budget gap for the coming year stands at an estimated $6.1 billion, with much of that shortfall attributed to the State’s Medicaid program.  In order to maintain a “global spending cap” imposed by Governor Cuomo on Medicaid spending, his administration shifted more than $1 billion in Medicaid payments into the next (2020) fiscal year.

            Governor Cuomo’s administration ascribes the Medicaid deficit to several factors, including the effect of an increase in New York’s minimum wage on health care providers, a phase-out of some federal funding, an aging population resulting in greater demand for long-term care, and the rising cost of that long-term care.

            We can’t cut Medicaid spending to the bone in order to comply with an artificially imposed spending cap without jeopardizing the health of millions of New York families who depend on this vital program.  As Chair of the Assembly Health Committee, I’ll be working to protect Medicaid patients by providing it with additional revenue on high-income earners.

Assembly Task Force on Opiate Addiction

            Across our state, New Yorkers have been struggling to overcome an epidemic of opioid abuse.  To help address the crisis, the NYS Assembly Majority has formed a “Task Force on Examining Socio-Economic Responses to People with Substance Use Disorders.”  I was appointed to serve on the Task Force by Speaker Carl Heastie.

            Opioid addiction does not discriminate, impacting New Yorkers of all ages, races, and genders across the state.  This Task Force will help guide the state’ response with the insight of stakeholders and experts in the field, as we work to break down barriers preventing access to care and services.

          The Task Force will convene hearings to receive recommendations on how to address the opioid epidemic, as well as learn about the impacts of substance use disorders on those that suffer from the disorder,

on their support systems, and on their communities.  

            The formation of the Task Force is not the first step that the Assembly has taken in 2019 to address the crisis; earlier this year, the Assembly and the State Senate allocated $1 million for NYS substance abuse and rehabilitation service.

Tues., Jan. 7: Workshop on “Cultivate Hell’s Kitchen”

       Do you live, work or play in Hell’s Kitchen?  Have ideas about what the future of this neighborhood should look like?  The “Cultivate HK” Town Hall series, sponsored by the Clinton Housing Development Company (CHDC), is designed to mobilize neighbors and advance a greener, more interconnected Hell’s Kitchen.    

            Join your neighbors at the second “Cultivate HK Town Hall” on Tuesday, January 7 from 6:00 p.m. to 8:00 p.m. at 545 West 52nd Street (between Tenth & Eleventh Avenues) on the first floor.🎉

            This event is free and open to the public, and refreshments will be provided.

            For more information, please email Ansley at apentz@clintonhousing.org.  You can RSVP online at http://bit.ly/TownHallJan7

Mulchfest! Through Sat., Jan. 11, Recycle Christmas Trees

            From now through Saturday, January 11, you can recycle your Christmas tree or wreath, courtesy of the New York City Parks and Sanitation Departments. 

            Just bring your tree to a Mulchfest location, and your tree will be turned into wood chips that will be used to nourish trees and make New York City even greener.  More than 28,000 trees were recycled last year.

Help the City top that number in 2020!

            In our Assembly district, drop-off sites are Central Park West and West 65th Street and on East 14th Street between Broadway and Park Avenue South.  Until Jan. 11, you can bring your tree to any Mulchfest location. Find the complete listing online at https://www.nycgovparks.org/highlights/festivals/mulchfest.

            Please remember to remove all lights, ornaments, and netting before bringing the tree to a Mulchfest site.

            Weather permitting, the NYC Department of Sanitation will also be conducting curbside collections for mulching and recycling of Christmas trees from Monday, January 6 through Friday, January 17, 2020.

Mon., Jan. 20: Deadline for Citizens Committee Grant Applications for Local Community Organizations

            Do you have an idea to improve our community?  The Citizens Committee for New York City is now accepting applications from volunteer-led groups for its Neighborhood Grants program, which offers up to $3,000 and project planning support for initiatives aimed at bringing neighbors together and improving the quality of life in neighborhoods across the city.   The deadline to apply is January 20.  An organization does not have to be a registered 501(c)(3) to be able to receive a grant from CCNYC!

            Eligible groups include block associations, tenant associations, PTAs, gardening groups, cultural organizations and others.  Examples of projects considered for funding include turning a vacant lot into a community garden or community composting site; facilitating workshops on healthy cooking and eating; beautifying public spaces; arts and cultural programs; youth fitness initiatives; and much more.

            Organizations can access the application for 2020 Neighborhood Grants online at www.citizensnyc.org/grants. For more information about the application process or eligibility, contact Arif Ullah, Director of Programs, at aullah@citizensnyc.org or (212) 822-9580.

Wed., Jan. 22: Workshop on SCRIE & DRIE

            SCRIE and DRIE (Senior Citizen Rent Increase Exemption and Disability Rent Increase Exemption) help eligible New Yorkers stay in affordable apartments by freezing their rent. 

            From 12:00 noon to 2:00 p.m. on Wed., Jan. 22, the New York City Mayor’s Public Engagement Unit will host a workshop on the SCRIE and DRIE programs in conjunction with the office of City Council Speaker Corey Johnson.  The event will be held at Selis Manor, 135 West 23rd St. between Sixth and Seventh Avenues in Chelsea. 

            To apply for SCRIE or DRIE, you must be at least 62 years old, or 18 with a qualifying disability; have a household income of $50,000 or less; live in a rent-regulated apartment (either rent-stabilized, rent-controlled, or a Single-Room-Occupancy hotel); and spend more than 1/3 of your income on rent. 

            To complete an application, you must provide photo identification; 2018 tax returns documenting the income of all household members; copies of your two most recent leases; and, if applicable, a copy of an Social Security Disability award letter or Veterans Administration disability or compensation notice of award letter.  Residents of NYHCA developments or Section 8 housing are not eligible.

            To RSVP for the workshop, please call 212-564-7757 or email SpeakerJohnson@council.nyc.gov.

Fighting to Preserve a Historic Fifth Avenue Building

      On December 18, I spoke at a rally to urge the NYC Landmarks Preservation Commission (LPC) to grant landmark designation to the Demarest Building at 339 Fifth Avenue.  An historic Beaux-Arts, iron-framed structure with four-story-high arched windows located on 33rd Street across from the Empire State Building, the Demarest was built in 1890 and originally housed a horse carriage showroom as well as the first electrically operated elevator in the world.  It was designed by the architectural firm of Renwick, Aspinwall & Russell, whose founder James Renwick also created the plans for St. Patrick’s Cathedral and the Smithsonian Institution in Washington, among many other famous buildings.  Unfortunately, the Demarest is facing demolition because its owner, Pi Capital Partners, has filed an application to construct a new high-rise building.

      I have previously joined with community members and electing officials in unsuccessfully urging the preservation of the Demarest and other historic buildings in the area as part of a proposed expansion of the Madison Square North Historic District.  Now, our effort to save the Demarest is assuming new urgency in light of the imminent threat to its survival.


FIGHTING TO PRESERVE NEW YORK’S HISTORY: Last month, I joined members of the 29th Street Association and other elected officials to rally support for designating the Demarest Building on Fifth Avenue as a New York City landmark.