2012-13 Executive Budget MRT Phase II Proposals

1. 2012-13 Executive Budget MRT Phase II Proposals February 1, 2012 Jason Helgerson, Medicaid Director John Ulberg, Medicaid CFO

2. 2012-13 Executive Budget Highlights • Includes 25 MRT Phase II recommendations. • Remaining workgroup recommendations will be included in MRT waiver process. • No traditional cost containment items. • Budget is “cap neutral” • Provides two year appropriation and extends super powers. • Preserves 4% annual spending growth. • Proposes State takeover of local administration and county fiscal relief. 2

3. 2012-13 Proposed State Operating Funds Spending ($89 billion) • Annual % Growth • Medicaid (4.0%) • School Aid (4.0% - school year basis) • State Ops/Fringe Benefits (-0.4%) • Debt (4.7%) • All Other Local Assistance (2.7%) 3

4. Total Medicaid Spending (dollars in billions) 4

5. MRT Phase 2 Key Reforms

6. MRT Phase 2 Work Groups • Program Streamlining & State/Local Responsibilities • Managed Long Term Care Implementation and Waiver Redesign • Behavioral Health Reform • Health Disparities • Health Systems Redesign: Brooklyn 6 Basic Benefit Review Workforce Flexibility and Change of Scope of Practice Payment Reform and Quality Measurement Affordable Housing Medical Malpractice Reform

7. MRT Phase II Recommendations (“-” denotes savings; dollars in millions) • Affordable Housing ($75 million in base) and Health Systems Redesign/Brooklyn (fiscal impact reflected in Payment Reform). • Net savings from phasing out growth in local Medicaid spending over three years is not included above. 7

8. Basic Benefit Review Recommendations • Expanding coverage of podiatry services for adult diabetics. • Providing breastfeeding support and tobacco cessation counseling. • Reducing payments for elective cesarean sections without medical indication. • Eliminating coverage for knee arthroscopy, back pain treatments, angioplasty, and growth hormones where there is no evidence of benefit. 8

9. Health Disparities Recommendations • Expanding services to promote maternal and child health, hepatitis C care and treatment, harm reduction counseling and services, and language accessible prescriptions. • Providing reimbursement for interpretation services for patients with limited English and communication services for patients who are deaf and hard of hearing. • Implementing and expanding data collection to measure disparities. 9

10. Payment Reform Recommendations • Essential Community Provider Network • Provides short term funding to address facility closure, merger, integration or reconfiguration of services. • Vital Access Providers (VAP) • Provides ongoing rate enhancements or other support during significant restructuring. • HEAL reserves of up to $450 million to ensure smooth transition of services within communities and to provide reinvestment capital. 10

11. New York Health Benefit Exchange • Establishes Exchange as public benefits corporation. • Nine member governing board. • Five regional advisory committees. • Thirteen policy studies. 11

12. New York Health Benefit Exchange 12

13. New York Health Benefit Exchange • With Planning and Establishment Grant Funding and Technical Assistance from the Robert Wood Johnson Foundation, New York has a series of Exchange activities underway: • Simulation Modeling • Business Operations Work Plan • Five-Year Exchange Budget and Self-Sustainability Analysis • Exchange Policy Studies 13

14. Medicaid Takeover – Fiscal & Administration Why is it the right time for the State to take over responsibility for county Medicaid program growth and administration? • Current 3% local Medicaid growth cap exceeds 2% Property Tax Cap. • MRT and Federal health care reforms require greater administrative centralization to achieve efficiency and effectiveness goals. 14

15. Local Medicaid Growth Phase-Down 15

16. Local Medicaid Fiscal Relief Phase Down Growth Starting in 2013, Effective April 1, 2013 (in millions) 16

17. Medicaid Administration Takeover • Federal Health Care Reform requires single point of entry. • Enables fundamental rethinking/retooling of how Medicaid program is managed. • Results: Services delivered more uniformly, efficiently, and cost effectively. • State savings from capping administrative reimbursement at FY 2012 levels partially offsets State costs of takeover. 17

18. Impact of Medicaid Administration Takeover/ County Cap Phase Down 18

19. Conclusion Work Ahead

20. MRT Conclusion • New York is poised to fundamentally transform its Medicaid program into a national model for cost-effective health care delivery. • New York is also well positioned to ensure that Medicaid reform also means more comprehensive health system reform. • The Medicaid Redesign Team has developed a multi-year action plan that if fully implemented will not only bend the state’s Medicaid cost curve but also improve health outcomes for more than 5 million New Yorkers. • To fully implement the MRT action plan, a ground-breaking new Medicaid 1115 waiver will probably be necessary. • Still a lot of work to be done: It is up to the state, stakeholders and the broader New York community to continue to work together to successfully implement this multi-year action plan. 20

21. MRT: Additional Information • MRT Website: http://www.health.ny.gov/health_care/medicaid/redesign/ • Sign up for email updates: http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm • ‘Like’ the MRT on Facebook: http://www.facebook.com/NewYorkMRT • Follow the MRT on Twitter: @NewYorkMRT 21

22. MRT: Questions? • If you have questions from today’s presentation, please join us on Twitter, Friday, February 3, 8:30 – 9:30 AM for an opportunity to ask questions and have them answered in real time. • How to participate in the live Twitter chat: • If you’re not already on Twitter, join at www.twitter.com • Follow the MRT on Twitter: @NewYorkMRT • Login to Twitter between 8:30 and 9:30 AM on Friday • Ask questions by including #NYMRT in your tweets, or • Directly tweet us by including @NewYorkMRT in your tweet • You don’t have to tweet – you can watch the conversation just by following @NewYorkMRT on Twitter – updates will show up in your news feed. 22