State Capitol Updates: Medicaid Issue & More

Dan Clark: Returning to New York by The Numbers, a segment where we tell you about something coming out of Albany using a number. This week that number is 38, remember that.

We're actually using that number to follow up on a segment from a few weeks ago. Long story short, three years ago, the state created a plan for cutting costs in Medicaid, and part of that plan that takes effect April 1st would change how Medicaid pays for prescription drugs. New York is moving to a fee for service model called NYRX. But what does that even mean?

Basically, it allows the state to directly negotiate drug prices, and that could save the state money, which is the whole point of the change. It would also allow Medicaid recipients to use more pharmacies, which is super important in rural areas where healthcare can be really hard to find. Pharmacists want the change because allowing the state to negotiate drug prices directly rather than going through so-called pharmacy benefit managers will actually put more money in their pockets through higher reimbursement rates. That brings us to the number 38.

Steve Moore, a pharmacist from Plattsburgh says the Medicaid reimbursement rates under the current model just don't cut it.

Steve Moore: On average, we're getting a $0.50 dispensing fee. I had a prescription the other day that was reimbursed at $0.38 total. 30 days supply of medication for patient’s heart medication, and it was $0.38. So, it’s tough. We've got rising minimum wage and, you know, do you really want your pharmacy employees to be minimum wage employees?

DC: One side effect of the change that we told you about a few weeks ago is that it would cut off certain safety net funding for community health organizations in a federal program called 340B. The state has said they'll help those groups bridge that gap, but that's not guaranteed. So those groups want to stop the change.

We'll know more when the state budget is approved, hopefully at the end of March.

Dan Clark: Advocates are pushing a shift in state government that they say would drive more than $2 billion in federal funding into the state's coffers. That would happen through something called data matching. Right now, New York administers certain federal safety net programs and approves people based on eligibility.

Among those programs are the Medicare Savings Program, the Home Energy Assistance Program, and SNAP (food stamps). The thing about these programs is that the eligibility requirements are pretty similar across the board. So, if you qualify for one of them, you may very well qualify for the others as well. But a lot of people don't know that.

So, a coalition of groups led by the American Association of Retired Persons (AARP) are calling on the state to do something called data matching. Basically, if someone's in one of these programs, advocates say the state could proactively see if they qualify for the other ones and let them know.

Beth Finkel is the New York state director at AARP.

Beth Finkel: Why aren’t we accessing benefits to all people, older adults who are eligible? The short answer is we can, and we should. Tapping this federal aid would not only help hundreds of thousands of low and middle income New Yorkers, but would also drive more money through economic stimulus into the state coffers, and to help us address other state budget needs.

DC: Again, that would be federal funding, not state funding.

In a statement, the Hochul administration said, “New Yorkers can currently apply for multiple benefits, including public assistance, SNAP, Medicaid, childcare, and other services by completing one application. Federal regulations strictly limit how information on SNAP recipients can be shared with other programs, but we remain committed to seeking ways to expand access to all benefits by increasing coordination and data sharing among programs.”

A spokesperson for the State Department of Health said they're reviewing the proposal.