Alliance Note: New York State’s Health Home program is at risk of a major funding cut which would gut providers’ ability to offer this effective service to the more than 170,000 New Yorkers who rely on it. Health Homes support people with chronic and complex medical needs get connected with providers and essential services such as housing and medical care. The program has been successful, leading to significant decreases in emergency room spending and outpatient care costs for people enrolled in the program.
Health Home providers and advocates are pushing the legislature to stop any proposed cuts as well as restore the cuts established in last year’s budget. New York must protect programs like Health Homes, which provide needed services in the community and prevent unnecessary hospitalizations. See below for more information.
Providers Say Budget Cuts Would Essentially ‘Terminate’ State’s Health Home Program
By Jacqueline Neber | Crain’s Health Pulse | February 27, 2024
The program helps coordinate care for New Yorkers with chronic medical needs and is some individuals’ only point of contact with the health care system, providers say.
Stephanie Ramirez, who works for the Downtown Brooklyn-based nonprofit Housing Works, recalls a patient with chronic obstructive pulmonary disease, HIV, hypertension, asthma and depression who was having trouble getting a portable oxygen tank. Without it, the patient was stuck at home and couldn’t attend necessary doctor’s appointments.
In light of this, a Housing Works case manager coordinated with the patient’s primary care provider, hospital, pharmacy and insurance to get the equipment, Ramirez said. The case manager is one of four Ramirez supervises, plus a care navigator who work through the state’s Medicaid Health Home program, which deploys teams of coordinators to help 170,000 New Yorkers with complex medical needs access providers, medication, mental health and substance-use care, and housing opportunities.
Several years ago, the state’s Health Home budget was about $500 million per year–but funding has trickled off, according to Matthew Lesieur, the executive director of statewide community organization coalition iHealth, and potential cuts are on the horizon. Gov. Kathy Hochul’s executive budget proposals would cut the Health Home budget by about $125 million, bringing the program total to just under $200 million. That would “essentially be terminating” it, he said: There are 30 designated Health Homes throughout the state, and that amount of funding could force some to shutter, Lesieur added.
Advocates and workers in the program say New Yorkers will lose access to care if the proposed cuts go through.
According to Ramirez, Housing Works has already had to shrink its program because of past budget cuts, as a result reevaluating patients’ eligibility and disenrolling some clients with lower needs.
State Health Department data released in January shows that emergency room visit spending fell by 28% and outpatient care costs by 54% for a cohort of Health Home members who were first enrolled in the program in the fourth quarter of 2021 and were part of it for at least nine months of 2022. But if patients lose access to Health Homes, they could return to emergency rooms for their primary care and drive expenses back up, Ramirez added.
Furthermore, Lesieur said, the state has not provided the organizations working within the program with an explanation of how the cuts would unfold.
“There is no policy behind it. No one has been able to provide an explanation of how you would cut $125 million from the program [or] what that would mean,” Lesieur said. “Would you have to cut everybody’s rates dramatically? Would you seriously limit who is eligible for the program? Those are unanswered questions.”
Lesieur acknowledged that Hochul’s budget emphasizes curbing Medicaid spending, which is expected to reach $31 billion for fiscal 2025. However, he questioned the governor’s reasoning behind chopping funding from Health Homes, which make up a relatively small portion of the Medicaid budget. The state has not provided an explanation behind the decision, he added.
Representatives from the state health department and the governor’s office did not address questions from Crain’s about why Hochul chose to propose cuts to the Health Home program specifically, but Cadence Acquaviva, a spokeswoman for the DOH, emphasized that the budget proposals would help ensure “responsible overall levels of Medicaid spending.”
Ahead of the governor’s final budget, Housing Works chief executive Charles King said his goal is to persuade legislators in the Senate and Assembly to restore the cuts that were enacted last year and prevent future cuts. On this front, he and other providers will be in Albany today.
“We’re hoping that if we can get at least one of the houses to include it, we can soften up the administration, since they haven’t articulated a good reason for the cut–or articulated what they propose to replace it with that is somehow less expensive and still gets the job done,” King said. Acquaviva added that Health Homes serve an important function in the health care system in caring for some of the state’s most vulnerable and the budget would prioritize funding them. The governor and the Legislature must arrive at a final budget agreement by April 1.