New York’s Medicaid Redesign

New York’s Medicaid Redesign Team: State Policy Changes Affecting St. Mary’s

With the vast majority of St. Mary’s patients enrolled in Medicaid, St. Mary’s closely monitors New York’s Medicaid policy. In 2011, New York State’s Medicaid program was the largest in the country, spending twice the national average in cost per recipient. In response, New York Governor Andrew Cuomo assembled the New York Medicaid Redesign Team (MRT), which was tasked, in part, with lowering Medicaid spending.

A major element of MRT’s plan is “Care Management for All,” which seeks to transition all New York Medicaid recipients to managed Medicaid programs. Under this model, the state contracts with private insurance companies that provide Medicaid coverage on the state’s behalf. Both parties agree upon a fixed monthly rate to be paid to the insurer, and the insurer is then charged with negotiating reimbursement rates for services delivered by a healthcare provider. This model of care provides fixed revenue to healthcare providers, thereby encouraging them to use resources more efficiently and to develop preventative and community wellness programs designed to reduce costs over the long term. This model, though effective in many healthcare settings, has not yet been fully vetted for the high-needs pediatric population.

The MRT recognizes that St. Mary’s cares for patients whose medical needs are far more extensive than most other providers in New York, and as such, our unique needs—as well as those of similar organizations—require further deliberation. According to the Children’s Hospital Association, children with medical complexity—such as those at St. Mary’s—comprise 6% of the total number of children on Medicaid and yet they account for nearly 40% of all Medicaid costs.1 The MRT will convene its workgroup on medically fragile children, with representation by St. Mary’s, to further discuss this high-needs population in the context of managed Medicaid. As more of our patients move to managed Medicaid in the coming year, reimbursements remain uncertain. In order to continue providing excellent, comprehensive care, St. Mary’s will rely increasingly on philanthropic support and private partners as a vital source of revenue.

In recent years, St. Mary’s leadership has maintained a regular presence in Albany, meeting with the Department of Health to ensure that new Medicaid policies properly account for New York’s most vulnerable children. St. Mary’s will continue to be a champion for our patients and for all other children with medical complexity as we continue to advocate for proper reimbursement rates. As we work to secure new rates, we will provide the same outstanding care, as made possible through the continued support of our invaluable philanthropic partners.

 

1 Optimizing Health Care for Children with Medical Complexity,” Report issued by Children’s Hospital Association, October 2013