NYAPRS Note: We’ve been hearing for some time about a growing NYS Medicaid spending crisis and a report released last Friday by NYS budget officials confirmed that NY budget officials are projecting a Medicaid deficit of $3.9 billion in the current budget year, which ends 4 months from now on March 31. Here’s more:
The $3.9 billion gap is caused by:
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$2.2 billion in cost overruns caused by increases in minimum wage, rate hikes to hospitals and nursing homes, a 27% increase in payments to financially distressed hospitals, loss of federal funding, a 13% increase in managed long term care and higher than projected enrollment in CDPAP
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The burden of paying for a $1.7 billion Medicaid gap that was deferred from last year’s budget into the current one
State officials’ plan to make up the current $3.9 billion gap by:
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cutting $1.8 billion via across-the-board reductions in rates paid to providers and health plans, along with “reductions in discretionary payments, and other actions that can be executed administratively in the current fiscal year”.
However, the state won’t release details about how these cuts will be levied until its January release of next year’s budget, which means that we’ll be looking to, as one observer put it, “make close to $2 billion worth of cuts in what will amount to about two-and-a-half months.”
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deferring another $2.2 billion into next year’s budget, which is currently expected to have a $6+ billion deficit.
Advocates will be meeting soon to look at strategies to address these projected cuts. Stay tuned for details.
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New York Faces Its Largest Budget Crisis In A Decade. This Is The Reason Why.
Joseph Spector, Rochester Democrat & Chronicle November 25, 2019
ALBANY – New York faces budget deficits between $6 billion and $8 billion over the next three years amid ballooning costs for Medicaid.
Budget documents released Friday afternoon showed the state faces its worst fiscal problems since the recession in 2010, when a $10 billion budget gap needed to be closed.
The state Legislature and Gov. Andrew Cuomo will need to come up with a balanced budget for the next fiscal year that starts April 1. A $6 billion budget gap for the 2020-21 fiscal year could mean deep cuts in programs and services.
The main culprit is exploding costs for Medicaid after the state was able under Cuomo since 2011 to largely keep spending growth to about 3% or 4% a year.
The state’s midyear budget update Friday showed deficits of $2.9 billion growing to $3.9 billion by 2023 in New York’s $70 billion Medicaid program.
So that is fueling an overall budget gap that is estimated to jump from $6 billion next year to $8.5 billion by 2023.
More than 6 million people are on Medicaid in New York, about one third of the entire state’s population.
“Thanks to Medicaid over-spending, New York’s state budget gaps have blown up to their highest levels since the Great Recession,” wrote E.J. McMahon, founder of the Empire Center for Public Policy, a fiscally conservative think tank in Albany.
New York’s Rising Budget Gap and What It Means For You
Lawmakers and Cuomo have dealt with relatively small budget gaps in recent years after having to deal with a $10 billion gap when Cuomo took office in 2011.
In Cuomo’s first year, he and lawmakers had to cut school aid by $1.3 billion or 6%, cut health-care costs and lower overall spending by 10%, leading to a series of concessions by labor unions that represent state workers to avoid mass layoffs.
Now they will face new pressures on how to balance the budget in the coming months.
Cuts shouldn’t be done solely within the Medicaid system, said Andrew Rein, president of the Citizens Budget Commission, a business-backed think tank in New York.
“Developing and implementing a plan to solve the entire budget problem need not be done entirely within the Medicaid program,” he said in a statement.
“Other portions of the budget also should be considered, including mistargeted school aid and unproductive economic development programs.”
The state budget’s biggest spending items are school aid and Medicaid, and while those have had spending growth in recent years, Cuomo has forced other state agencies to largely keep their spending flat.
New York also doles out billions of dollars a year on economic-development programs to promote job growth and had a $1.3 billion property-tax relief initiative.
Schools are also limited in the ability to raise property taxes to cover any decrease in state aid. A property-tax cap makes it exceedingly difficult to raise school taxes more than 2% a year.
School groups are already lobbying for a $2 billion increase in aid for the 2020-21 year. This year, school aid rose by $1 billion, to a total of $27.9 billion — by far the most per capita in the nation.
“As schools seek to offer the range of academic programs needed to prepare today’s students for success in tomorrow’s economy, the fact is that it will take more of an investment to get it right,” the New York State Educational Conference Board said Thursday.
Why Is New York in This Position?
State officials and experts said the fiscal woes are not a result of an economic downturn, which is usually the case. Instead, it is health-care costs.
“This is different because it is a significant deficit not in the context of any kind of economic downturn,” said Bill Hammond, the Empire Center’s director of health policy.
“It’s a Medicaid problem,” he added.
Enrollment in the state’s managed long-term care program has been growing at about 13% a year, up to a total of about $8 billion this year.
New York splits Medicaid costs with the federal government, and counties also pay a capped portion.
Medicaid has helped New York lower its uninsured rate to its lowest on record at 4.7%, according to the federal Centers for Disease Control and Prevention.
But the increased enrollment has come at a cost amid a decline in federal aid for Medicaid expenses, said Freeman Klopott, a spokesman for the state Budget Division.
Also, New York’s Medicaid program is spending $770 million this year to support financially distressed hospitals, a 27% increase, he said.
He said a cost-cutting plan will be part of Cuomo’s budget proposal in January.
“With increased utilization and medical inflation nationally creating a structural imbalance,” Klopott said in a statement, “the Division of the Budget and the Department of Health are once again developing a cost-curbing plan that will be described in the Executive Budget to be introduced in January and continue high-quality care for more than six million New Yorkers.”
Fiscal watchdogs warned about cutting too deep into New York Medicaid’s program, which is one of most robust in the nation.
Part of the plan calls a $2.2 billion lag in Medicaid payments to health-care organizations. The other calls for a $1.8 billion “savings plan,” McMahon said.
Rein called it, “one part gimmick and one part delay.”
“The state will make permanent a $2 billion payment deferral, which simply perpetuates papering over the structural problem,” he said.
“For the remainder, the state again delays presenting a savings plan. Delays only serve to make the solution more painful.”