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Memorandum of Support

Empire Justice Memo of Support: Include a Health Exchange in the Final Budget

New York Must Include Health Insurance Exchange in Final Budget, Accept the Executive’s Proposal for State Takeover of Medicaid, and RejectProvisions that Would Delay State Takeover of Medicaid Administration


Empire Justice Center strongly urges passage of a health insurance exchange and would also like to express concerns about proposals in the Senate’s and the Assembly’s budget amendments that would delay or require additional studies of the State’s assumption of Medicaid administration.  
Failure to authorize a state exchange and state takeover means Medicaid will not be integrated into the health insurance exchange in New York.  Low-income New Yorkers will lose out on the opportunity for one-stop screening and assessment.  Gaps in coverage will be inevitable as family incomes fluctuate between public health insurance levels and eligibility for federal subsidies in the Exchange.
Our Senior Attorney, Trilby de Jung has participated over the last nine months on the State/Local Responsibilities Medicaid Redesign workgroup, which is composed of county executives, commissioners of social services, consumer advocates, and representatives of provider associations and organized labor.  The workgroup shares the Legislature’s belief, expressed in both chambers’ budget amendments, that the transfer of administrative responsibility from the local districts to the Department of Health must be carefully considered.  That is the job with which the group has been tasked and on which it has been working diligently for the past nine months.  
It has been a difficult charge to construct a plan for transferring enrollment, eligibility and oversight responsibilities that balances the counties’ needs for mandate relief, the Department’s ability to absorb the workload given current staffing and technology, and the expectations in both state and federal law that consumers have a convenient and efficient pathway to access health insurance.  Nevertheless, the Workgroup has managed to achieve consensus on a series of recommendations that meet these competing demands.  Those recommendations were included in the Executive Budget proposal.  
There is also consensus among the Workgroup that this transition cannot be delayed, which is the inevitable outcome if the final budget agreement includes either the Senate’s or Assembly’s recommendations for additional studies.   The Workgroup has studied the issues and has developed a plan.  The State Department of Health needs the authority, resources and flexibility provided in the Executive budget language in order move forward.  Counties, held to a property tax cap and perhaps a cap on administrative expenses, need the promised mandate relief that the transfer of Medicaid administrative responsibility was intended to provide, and they need it immediately.  The State administrative takeover, together with the assumption of Medicaid growth, represents the only mandate relief that will save counties significant money in the next several years.
Empire Justice Center urges the Legislature to consider the numerous and significant ways in which the transfer of administrative responsibility is intertwined with the federal law.  It is critically important that the State begin, without further delay, the consolidation and modernization of its enrollment and eligibility infrastructure systems.  If this does not proceed in a timely manner, local districts will be overwhelmed with an estimated 500,000 additional, in-person applicants for health insurance and insurance premium tax credits beginning in 2014.  

Federal funding to reimburse providers for uncompensated care will be sharply cut, but will not be offset by newly insured patients if New York does not have a consumer-friendly and efficient system through which families can enroll for coverage.  Additionally, the State may lose the opportunity to make needed technological upgrades with federal dollars.
Therefore, Empire Justice Center respectfully urges the Legislature to:

  • Pass the health insurance exchange, and
  • Accept the Executive’s proposal for State takeover of Medicaid administration and reject provisions that would delay the state takeover of Medicaid administration.