March 30, 2012

2012-13 Health and Mental Hygiene Budget Maintains Vital Programs and Enacts Historic Medicaid Reforms
The Takeover of the Three Percent Medicaid Growth Factor Will Save Counties and New York City $1.2 Billion Over Five State Fiscal Years

Assembly Speaker Sheldon Silver, Assemblyman Richard Gottfried, Co-Chair of the Joint Conference Subcommittee on Health and Aging, and Assemblyman Felix Ortiz, Co-Chair of the Joint Conference Subcommittee on Mental Hygiene, announced today that a budget agreement has been reached that provides vital funding to protect New York's most vulnerable patients and ensures working families have access to quality health care by providing $56 million in additional support for health and mental hygiene programs.

"Making sure all New Yorkers, particularly those on the margins, have access to affordable health care has been a cornerstone of the Assembly Majority's agenda for many years," said Silver. "The 2012-13 state budget keeps this commitment by making sure vital resources are available to protect and improve the quality and accessibility of health care while helping to control costs."

"The 2012-13 state budget includes important reforms and cost saving measures that are prudent given the economic realities of our state," said Gottfried, Chair of the Assembly Health Committee. "The new budget protects important public health initiatives. It helps protect access to long-term care, including assuring continuity of care for Medicaid enrollees transitioning to managed long-term care."

However, Gottfried added, "the Senate's refusal to support the creation of a health insurance exchange is a real obstacle to millions of New Yorkers getting quality affordable health coverage."

"As legislators, it is our job to protect our children, seniors, working families, and our most vulnerable citizens," said Ortiz. "This budget takes a responsible approach to ensuring that vital services are not compromised as a result of budget cuts."

The 2012-13 enacted budget provides more than $56 million in additional support for health care programs across the state. The budget effectively increases government efficiency and protects programs that are designed to aid communities across New York State.

Restoration of "prescriber prevails" for Medicaid recipients

The 2012-13 state budget restores prescriber prevails for antipsychotic drugs so that the decision regarding the medications a patient with psychiatric conditions should receive remains in the hands of the doctor and the patient, not the insurance company.


The 2012-13 budget includes provisions that would expand Medicaid coverage to include:

It also restores Medicaid coverage for enteral formula for HIV related illnesses and other conditions.

The spending plan outlines the process of transitioning Medicaid administration to the state. Responsibilities transferred to the Department of Health (DOH) would include, but are not limited to, processing Medicaid applications, making eligibility determinations and authorizing benefits. In 2013-14, local government Medicaid growth will be reduced to two percent, and then reduced by an additional one percent annually over the subsequent two years so that in 2015-16, counties and New York City will no longer have to contribute toward the growth of Medicaid expenses.

The takeover of the three percent Medicaid growth factor will save counties and New York City $1.2 billion over five state fiscal years. The phased takeover of local government administration of Medicaid will realize significant savings for local governments and help New York achieve reforms proposed at the state and federal levels. The budget continues the two year appropriation structure and limits the Department of Health's spending to four percent, commensurate with the Medicaid global spending cap.

Estate Recovery

The 2012-13 budget includes provisions to repeal the 2011-12 state budget provision that expanded estate recovery rules to allow the county departments of Social Services to recover more assets from the estates of deceased Medicaid recipients.

Early Intervention (EI)

The E.I. program is the statewide system of early intervention services for infants and toddlers with disabilities and their families. The 2012-13 state budget includes provisions that would transfer the responsibility for paying provider claims from the counties to a statewide fiscal intermediary. It would shift the authority for approving E.I. providers from local health departments to the state DOH. It would also eliminate the two percent across-the-board reduction on early intervention program payments.

The spending plan rejects the requirement that E.I. providers contract with insurance companies, and preserves the ability for children to receive E.I. services by rejecting the ban on providers that have a working relationship with evaluators.

The budget also includes provisions that would require service coordinators, with parental consent, to provide notice to the Office for People with Developmental Disabilities (OPWDD) if a child appears eligible for OPWDD services. This will help eligible children with disabilities obtain earlier access to certain home and community based service waivers in addition to or in lieu of E.I. services if appropriate.

Improve educational services for youth residing in Office of Mental Health hospitals

The state budget establishes a pilot program to provide students residing in OMH hospitals a more appropriate education that comports more closely with the curriculum and related therapy services they would receive in their home school districts.

The state budget also includes funding for the following programs: