Medicaid Redesign Statement of Principles
Published on January 31st, 2011
The New York State Catholic Conference offers a statement of principles for redesigning and reforming the Medicaid system in New York State.
Statement of Core Principles Regarding Medicaid Reform
With the serious economic crisis facing New York State, it is only reasonable that one of the largest items in the state’s budget, Medicaid, be examined for savings and efficiencies. The New York State Catholic Conference therefore applauds Governor Cuomo and members of the Legislature, who have pledged to undertake the serious task of redesigning the Medicaid system.
We often hear it reported that New York spends more on Medicaid than any state in the union, including some with much larger populations. However, this fact must be understood in terms of New York’s proud, historic tradition of caring for those who are poor and vulnerable and seeing access to health care as a fundamental right. Rather than simply lament the cost of Medicaid, let us instead lament the overwhelming poverty, caused by many complicated factors, that leads so many of our citizens into this public safety net. New York’s commitment to these populations is commendable and must not be shaken, even in these difficult times.
The Catholic Conference historically has served as a voice for this voiceless segment of our society, and we will continue to advocate on their behalf throughout this process. But we also urge the Governor’s Medicaid Redesign Task Force to listen to the recipients’ stories themselves and get their input on the future of the programs that they have come to depend on. Recipients of services offer a unique perspective in this discussion and may well surface valuable suggestions for finding efficiencies in the system based on their own lived experiences.
In addition to speaking for recipients, the Catholic Conference is a voice for the state’s Catholic health care and human services ministries. The Church remains the largest nonpublic provider of health care and human services in the state. We are driven by a Gospel-based mission with core values of compassion, respect and reverence for all human life, justice and a commitment to excellence. As such, the Catholic Conference has unique insight into the difficult task facing the task force. With that background we offer several principles which we believe need to be applied to reform of the Medicaid system:
Respect for the dignity of human life: More than $45 million in state and local taxpayer dollars are spent each year on induced abortions through the Medicaid program, many of them at under-regulated storefront clinics that pose a risk to women and children. New York is one of only four states that have voluntarily chosen to appropriate Medicaid funds for elective abortions; the vast majority of states follow the lead of the federal government and fund abortions only in cases of reported rape, incest or when the mother’s life is in danger. At a time of cost-cutting for essential Medicaid services, we strongly urge that Medicaid dollars be used solely to provide life-affirming health care and not for elective abortions. Reform of Medicaid must not encourage discrimination against the sick, elderly or uninsured through the rationing of health care treatments based solely or primarily on their economic cost.
Maintain access to services: Any redesign of Medicaid should not negatively impact the life-affirming health care services to the poor and vulnerable populations the system is intended to serve. Savings can be achieved by efficiencies in the delivery system; standardization of methodologies in reimbursement, auditing, billing and other areas; the rooting out of fraud, and other means without a reduction in services.
Continued outreach to eligible individuals and families: The enrollment process needs to be streamlined in order to facilitate initial enrollment and reauthorization. Thousands of individuals and families across the state are eligible for publicly funded health programs such as Medicaid, Family Health Plus and Child Health Plus but are not enrolled. We know that people who do not have insurance delay or forgo needed health care, significantly increasing the eventual cost to the system and resulting in greater negative health outcomes.
Maintain benefits: In seeking savings, it may be tempting to look at reducing or eliminating existing benefits that are not always considered “basic care,” such as behavioral health, dental, and vision coverage. This would be a short-sighted approach because in reality, these services have a profound impact of the overall health status of the individual. Eliminating routine and preventive care in these areas likely will result in exploding costs in the not-so-distant future and dramatically impact the quality of life for patients.
Provide adequate reimbursements to providers to ensure viability of programs and services: The Medicaid crisis cannot be solved on the backs of recipients, but neither can it be laid at the feet of providers. Already, institutions in low-income areas, oftentimes Catholic hospitals, bear a disproportionate share of Medicaid caseloads. When reimbursements are cut, these institutions are naturally impacted more than those in higher income areas, putting their viability at increased risk. The services provided by these institutions cannot continue to exist with a continued downward curve of diminishing reimbursement and the growing cost associated with redundant mandates. Efforts to eliminate fraud and abuse need to be distinguished between human error and intent to inappropriately enrich oneself. When values-based facilities that care for those for whom no one cares are squeezed out of existence, it is the poor who suffer the most.
Build upon the success of managed care: Medicaid managed care has been a success in New York, growing from a demonstration in the first Cuomo administration to a program achieving quality scores exceeding national averages and in many cases meeting or exceeding commercial insurance performance. Additional populations whose coverage is through a fragmented fee-for-service delivery system could be transitioned into managed care, with resultant cost-savings and quality improvement. Additionally, the managed care benefit package should be comprehensive, with the inclusion of all behavioral, pharmacy and personal care services, so that care for the person might be better integrated and coordinated.
Promote home care: When individuals are able to remain in their home and community, it not only serves the patient well, it creates a tremendous savings over institutional care. The state should continue to invest in and promote home care options for cost-effective, compassionate, coordinated care.
Integrate long-term care planning: The state must not forget its most elderly residents who are at the stage of life that they need long-term care solutions. In redesigning Medicaid, we must commit to a system of reimbursement that will pay for the necessary and reasonable costs of long-term care services that will meet acceptable standards for quality of life as well as quality of care. Furthermore, we urge the requirement of a comprehensive care plan for every nursing home-eligible individual which reflects the full range of human needs, including spiritual fulfillment, and which takes into consideration the availability of institutional and home- and community-based services appropriate to the needs of each such individual. Although New York State and its localities authorize, finance, regulate and provide a vast array of home- and community-based services, the fragmentation of these services and the lack of integration of the funding streams that support them diminish their value for the individuals whom they are intended to benefit. Comprehensive care plans will promote savings in the system by facilitating home- and community-based care solutions for individuals who might otherwise be taking up a costly nursing home or hospital bed.
Comprehensive conscience protection: Medicaid redesign must protect the conscience rights of individual and institutional health care providers. Both federal and New York State policies have long respected the rights of health care providers not to be involved in abortions or direct abortion referrals. The Medicaid program must maintain this protection and extend it to moral and religious objections in other areas where services are proscribed by the religious beliefs of a provider. No person or institution should be compelled by law to participate in actions which violate fundamental religious and moral beliefs or mission statements.
The Catholic Health Care system in New York state includes 30 hospitals, 172 clinics, 54 nursing homes, 6 hospice programs, 20 certified or licensed home health care agencies and 14 long-term home health care programs, serving a total of more than 1.7 million New Yorkers per year. Our Catholic Charities agencies serve 1.6 million individuals per year, providing dozens of services including many with a Medicaid component, such as 72,000 recipients of mental health counseling, 10,000 recipients of addiction treatment, 3,000 recipients of pregnancy services and nearly 30,000 recipients of HIV/AIDS and other health-related services. Furthermore, more than 640,000 New Yorkers are enrolled in Medicaid or Child Health Plus in 58 counties through FidelisCare New York, the statewide managed care plan.
January 28, 2011