January 20, 2011
How quick is too quick when overhauling a $53 billion program?
New Yorkers talk fast, walk fast and eat fast. And some seem to believe they can do something else fast -- jump-start a serious overhaul of the state's budget-eating Medicaid program by spending less than two months soliciting reform ideas from interested parties.
Since Andrew Cuomo took the governor's chair in January, his office has pledged to make Medicaid reform an open process. Indeed, his office has set up a web site to solicit input from those who deal with Medicaid, and has arranged seven public forums around the state.
What's been given short shrift, however, is that his Medicaid redesign team has a mere 46 days from the date of its first meeting to collect comments and deliver an initial budget-saving proposal on March 1. (Wisconsin, the state New York is using as a model for reform, took four months to collect community input and deliver a plan, said Beth Kaplan, senior communications specialist at the Wisconsin Department of Health Services).
Those who will get hurt in the end are likely be Medicaid recipients, said Lara Kassel, who is part of the redesign team and the coordinator at Medicaid Matters New York, which advocates on behalf of the state's nearly four million Medicaid recipients. Sixty-four thousand of those people are HIV positive, according to the New York State Department of Health, and changes in the system will enormously impact their lives.
"The questions remain: What happens to all the information collected at meetings?" said Kassel. "Does it just go on to some list somewhere that is not considered? With the short time frame ... we don't know how all that will be handled."
Cuomo abbreviated the solicitation process and set the March deadline to ensure the team finds savings before the April 1 start of the fiscal year. The team will then turn to creating a longer-term cost-saving plan by November.
Kassel worries that the hasty process will fling much of her team toward options that are politically expedient but painful for Medicaid recipients. She thinks her peers could be tempted toward an across-the-board cut or the removal of services like dental care.
A contingent of the redesign team hit the road this week to begin soliciting specific reform proposals from health providers, Medicaid recipients and others. But Deputy Secretary for Health Jim Introne, who is also the director of health care redesign, was surprisingly uncertain when asked if the voices of Medicaid recipients would be included in the March plan.
"You could raise that question with respect to any interest group," he said calling from the car on the way to one of the community forums upstate. "There really is no assurance that I can provide at this point, except to say that we're looking to various stakeholders for input. And that we're looking to reduce expenses while providing quality. ... We're not going to know until the end of the process whether we'll be able to achieve that."
At the least, all proposals solicited will be posted on the web site, he said.
"Sure we're concerned about the tight time frame, but we have a fiscal year [starting] April 1," he said. "We'll just have to do the best we can."