NYAPRS Note: While NYS Governor Andrew Cuomo offered few details on proposals to address New York’s $4 billion deficit in Medicaid spending, he did share concerns about local management of the program. After the speech, Assembly leader Carl Heastie reiterated his opposition to cuts in services to vulnerable New Yorkers.
The Governor did roll out a number of very laudable new initiatives, most notably in the areas of suicide prevention amongst veterans, law enforcement and first responders; expansion of access to Medicaid assisted treatment, peer support, telehealth and mobile clinics with a special focus on reducing addiction within the LGBTQI community and new strategies to improve student mental health support by creating trauma informed educators.
As we await full details in the Executive Budget proposal, NYAPRS is encouraging our community to make plans to come to our annual Albany Legislative Day on February 25th to press for priorities that include Medicaid spending, human service nonprofit sustainability funding, housing rate hikes, passage of the Human Alternatives to Longterm Solitary Confinement (HALT) legislation and strategies to advance trauma-informed care in New York.
See more details at https://tinyurl.com/qnr9gqf.
NYAPRS Healthcare Highlights from Governor Andrew Cuomo’s 2020 State of the State Address
While emphasizing the acute challenge New York faces in addressing the looming Medicaid shortfall, amounting to $1.8 billion in unspecified cuts and $2.2 billion in deferred payments, NYS Governor Andrew Cuomo offered few details about the proposals his Administration will offer in the FY 2020-21 Executive Budget Proposal. Similarly, there were no new details about how we should address the deficit in the current budget since he imposed a 1% reduction across most Medicaid payments that fortunately exempted mental hygiene programs.
He did, however, express concerns on how counties have been managing local Medicaid programs since they were released from having to provide a local contribution in 2013. It’s too easy to write a check when you don’t sign it,” the governor asserted. “The situation is unsustainable. We’re paying $177 million on behalf of Eric, $175 million on behalf of Westchester, $2 billion on behalf of the City of New York to cover local costs,” he said.
The governor vowed to “restructure” the program this year and to increase local “accountability.” While observers quickly inferred that Cuomo meant he would try to force localities to pay a greater share as a bailout of sort, spokesperson Rich Azzopardi quickly noted that the governor was not discussing a possible lifting of the property tax cap. Budget watchdogs applauded Cuomo for confronting the Medicaid problem, but said it would be a mistake to force local governments pay a greater share of the costs. “The state needs to control the costs and not shift the costs to local governments,” said Bill Hammond, a health care analyst with the Empire Center for Public Policy.
Legislative leaders offered their initial reactions after the speech. Assembly Speaker Carl Heastie said the issue is about Medicaid growth rather than lack of available funds, adding “it’s going to be a long and complicated conversation because … we really don’t want to see services to people being cut. We have 95 percent of the people in the state receiving health care. We don’t want to see that number go down.” Senate Majority Leader Andrea Stewart-Cousins’ comments were very general: “it’s going to be pivotal in terms of our budget negotiations but putting forth the other issues that are also of concern is important.”
The Governor did highlight several new healthcare initiatives he will launch this year:
Addressing Veteran and Law Enforcement Suicides and Homelessness
He noted that, “while suicide is the 10th leading cause of death in the United States, risks are much greater amongst veterans, law enforcement, fire fighters, correctional officers, and first responders. National data show that more law enforcement officers die by suicide than are killed in the line of duty, a fact New Yorkers witnessed with several tragic NYPD officer suicides last year. Exacerbating the problem is the fact that veterans, first responders, and law enforcement personnel often fail to seek help in times of distress because of the stigma and detriments of seeking mental health assistance in their respective professions.”
Accordingly, the Governor will
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invest $1 million to partner with organizations to help veterans, law enforcement and first responders with suicide prevention efforts
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direct state agencies to expand suicide prevention strategies for veterans, law enforcement, correctional officers and first responders, including a new campaign by the Office of Mental Health to reduce the stigma of mental illness.
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convene a panel of stakeholders and experts at its annual Suicide Prevention Conference to develop and implement strategies for preventing suicide among these special populations and
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invest $5 million to expand permanent supportive housing for homeless veterans through the state’s Homeless Housing and Assistance Program (HHAP).
Expand Access to Medication Assisted Treatment
The Governor noted that his administration has already required that Medicaid and each plan have one MAT drug per therapeutic class with no prior authorization, and that if there is a prescription or refill for a drug not on the formulary that a five-day supply be given, and prior authorization is completed within 24 hours.
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This year, he will propose a single formulary for Medicaid that will ensure access to medication assisted treatment is granted quickly and efficiently without erecting unnecessary barriers to care.
Reduce Rates of Addiction in the LGBTQ Community
Governor Cuomo will direct the New York State Office of Addiction Services and Supports (OASAS) to
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develop clinical practice standards for addiction treatment programs when working with LGBTQ individuals. In developing these standards, OASAS will outline best practices to ensure an environment that is free from discrimination and understands the link between an individual’s addiction, LGBTQ identity, and specific health care needs.
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OASAS will also implement an accompanying endorsement for programs that meet these standards so that consumers can identify programs that are providing the best quality of care to LGBTQ individuals.
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the Office of Mental Health will review and approve clinical review criteria for mental health services, directing insurers to eliminate categorical exclusions for gender affirming services so that individuals receive the medical necessity review they deserve. employees and their family members.
Address The Opioid Epidemic
From July 2016 to September 2017 there was a 30% increase in visits for opioid overdose. The Governor will propose a multipronged approach in order to better connect ED patients with OUD to ongoing community care that will include the following:
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expand the Buffalo MATTERS pilot which provides MAT to patients identified with Opioid Use Disorder in Emergency Departments. These individuals will rapidly be transitioned into long-term treatment at a community clinic of their own choosing, all within 24-48 hours.
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The Department of Health (DOH) and the Office of Addiction Services and Supports (OASAS) will also establish a Buprenorphine prescription voucher program that provides a seven-day emergency supply of MAT as a bridge to insurance coverage and formal care. Finally, the proposals will improve access to MAT by connecting emergency departments with doctors who can prescribe buprenorphine through telehealth.
Expanding Access to Telehealth and Mobile Clinics
The Governor will
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direct OASAS to add ten new mobile clinics, one in each economic development zone statewide. In addition, in order to ensure access to addiction treatment in rural areas of the state, OASAS will provide funds for at least one treatment program in each county across the state to acquire equipment needed for telehealth services.
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direct Department of Corrections and Community Supervision (DOCCS) to expand access to medication-assisted treatment by providing buprenorphine in the seven facilities currently offering methadone.
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direct DOCCS to seek national certification and accreditation to operate an Opioid Treatment Program (OTP), creating the Nation’s first state corrections-operated OTP in the country.
Connect New Yorkers Seeking Addiction Assistance to Peer Support
Governor Cuomo
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has directed OASAS to reorient its existing HOPEline Services to provide a compassionate and supportive resource to find treatment, recovery or other supports. This centralized point of contact will utilize certified recovery peer advocates with lived experiences that can connect individuals with substance use disorders or their families with local resources, general referrals and a live person to speak with who will actively listen, engage and support the caller.
Improve Student Mental Health Support by Creating Trauma Informed Educators
The Governor noted that research has suggested that adverse childhood experiences (ACES), which are traumatic events that happen in childhood, can have serious detrimental effects across the entire life span. In New York State, over 45% of children have at least one ACE.
Emphasizing that “schools must be better equipped to support the evolving needs of the students,” he proposed:
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a new grant program for school districts to support local mental health initiatives supporting students. Through a competitive grant schools may apply for grants to support training on various proven approaches to providing mental health support for students. This includes education and training in trauma informed care, therapeutic crisis interventions, and other methods to better understand and react to certain behaviors that stem from trauma and ACES as well as mental health services and professionals.
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Schools with existing proven programs would eligible for grants to expand their programs. Economic insecurity is the most common ACE faced by children in New York, so grants will prioritize schools with high number of children in poverty.