Lawmakers want a say in Cuomo’s waiver spending
ALBANY—State lawmakers are trying to ensure they have some role in determining how the first half of the state's $8 billion Medicaid waiver will be spent, after Governor Andrew Cuomo's preliminary budget granted his administration a virtual blank check to allocate the federal funds.
Cuomo's proposed budget would treat the first $4 billion of waiver funds much like a discretionary program, with health care organizations and hospitals submitting applications, which would then be scored on a weighted set of qualitative criteria. Hospitals would have to meet federal performance standards to continue receiving aid, but the process would give the state's health department almost total control over how the funds are distributed, with little input from lawmakers.
“What we’re talking about is transforming the delivery of health care,” Senate health committee chairman Kemp Hannon told Capital on Thursday. “Now it’s a very modern, cutting-edge type of transformation. So that’s a policy. Part of changing policy ought to involve your elected representatives. That’s self-evident.”
Hannon said Senate Republicans, who control the chamber in a power-sharing arrangement with a group of five breakaway Democrats, will include language in their own one-house budget proposal to scale back some of the administration’s broad authority to disburse the Medicaid funds. Hannon said the current budget language is “not appropriate to go forward.”
The Senate Republicans would prefer the money go through a regional allocation process, in order to benefit all of the state’s hospitals, not just the struggling Brooklyn facilities that Cuomo made a focus of his efforts to secure the waiver.
Cuomo had pitched the waiver as a lifeline for struggling hospitals in the borough. At a joint press conference with New York City Mayor Bill de Blasio late last month, the governor again urged the federal government to approve the Medicaid money, while seated under a banner that read “Protecting Brooklyn’s Hospitals.”
But Hannon said the money should be viewed as "a regional allocation."
“Over the past 24 months, we have dealt with hospitals with financial troubles in every part of the state,” he said.
The state Assembly is also considering legislative changes to a proposed contract that would help distribute the funds.
A budget amendment proposed by the administration last week would allow the state health commissioner to expand an existing $52 million contract with a Long-Island based not-for-profit to help administer the waiver funds. The change would also remove the state comptroller's oversight of the contract.
Under the terms of the proposed amendment, the state health commissioner would be empowered to increase the size of a contract with the Island Peer Review Organization, which currently helps the state review its Medicare Quality controls, to assist in distributing money from the waiver. That would allow the organization to hire more state and private employees, outside of the state’s normal bidding and contracting rules.
The Assembly changes, which could be included in its one-house budget bill, would restore the state comptroller's authority to audit the contract.
A spokesman for the state’s budget department said removing the contracting requirements would allow the state to distribute the waiver money quickly, to comply with a tight timetable established by the federal government as part of the waiver agreement.
“Similar to actions taken in previous years, the budget would streamline the procurement process in specific situations where a potentially lengthy contracting period could jeopardize implementation timeframes,” said Morris Peters, a spokesman for the Division of Budget, in an emailed statement. “We’re seeking technical expertise that the State doesn’t have given tight timelines and the multiple demands on the Department of Health.”
But Hannon said the administration needed to involve more state government officials in the waiver process in order to help educate state constituents about the process. The waiver, he said, would likely lead to hospitals downsizing their facilities as they try to deliver cheaper, more efficient forms of care.
But that process has met with costly, prolonged protests, in the case of Long Island College Hospital and Interfaith Medical Center in Brooklyn.
“The public at large doesn’t understand this cutting-edge transformation of hospitals," Hannon said, comparing the process to the state's rocky implementation of the Common Core education standards. "Unless you're going to involve your elected representatives, you’re just asking for a very mysterious process, one done behind closed doors.”
“Changing policy may have to happen for care of more people, but you can’t just dictate it,” he said. “You have to involve people.”