Medicaid Redesign in Rockland

BY MICHAEL CAHILL

Last January Governor Cuomo issued an executive order, which created New York State’s Medicaid redesign team with the purpose of reducing the cost of Medicaid in New York, while also increasing the efficiency and quality of the program statewide.

The fiscal year 2011 – 2012 saw the redesign team develop a package of reform proposals that achieved the Governor’s Medicaid budget target. These reforms are not only changing how Medicaid is funded in New York, but also the system itself.

Medicaid is a program mandated by the federal government for individuals who cannot afford to pay for their medical care. In Rockland County, increased demand for Medicaid, due to the recession and population growth has put pressure on the system and increased the cost of providing these services. With new legislation and reforms from the state’s Medicaid Redesign Team, how Medicaid is funded in Rockland will be changing.

Legislation, (S.5889C / A.8644A) in the New York State Senate authored by Senator Patrick M. Gallivan (R,C,I – 59th District) will begin a shift in the funding of Medicaid. This bill calls for the gradual take over of the local share of Medicaid funding by the state government over the next eight years.

Federal, state, and local governments have funded the program. As of 2012 in New York the federal government pays for 50 percent of the program, the state government 33 percent, and local or county governments 17 percent.

In Rockland, from December 2006 to May 2011, there was a 38 percent increase in the number of individuals receiving Medicaid benefits. This increase has had an impact on Rockland’s budget. From 2006 to 2010 the county spent more than $286 million on Medicaid expenses. While the local cost of Medicaid decreased 7 percent in 2010 due to stimulus funding, the overall cost of Medicaid services have increased more than 38 percent since 2006.
Medicaid costs in Rockland are less than 10 percent of the county budget, however those costs account for nearly 80 percent of the budget for the county’s Department of Social Services.

Currently New York State caps rising Medicaid costs at 3 percent a year for local governments. Any costs above that 3 percent from one year’s budget to the next are shouldered by the state. More savings in the cost of Medicaid will come to counties over the next few years, as all recipients will be required to enroll in a managed health plan (similar to an HMO) by 2014.

The Medicaid system as it stands now requires states to provide 14 mandatory services. There are an additional 30 or so services, which are optional, that states can choose to provide.
Currently New York is one of the states to offer all mandatory and optional services to Medicaid recipients, which many critics blame for New York having the highest Medicaid costs per capita in the United States. However, legislation (S.1813 – Ranzenhofer) also supported by Senator Patrick M. Gallivan, would allow counties to “opt-out” of providing optional Medicaid services, meaning counties could tailor their Medicaid programs to fit local needs.

Its approval in the State Senate is unlikely says Ruth Masterson, Special Projects Assistant at the Rockland Department of Social Services. “The services that are optional, no one would take from someone in need. Who’s going to be pick and choose? Everyone needs different things,” said Masterson.

Rockland County’s Department of Social Services with a staff of 400 people says they have handled the rising demand for Medicaid in recent years with attention to detail and efficiency. “We’re maybe not as fast with processing claims as we used to be,” said Susan Sherwood, Commissioner of Rockland’s Department of Social Services, “but we’ve handled the volume and are providing services to the people that need them.”