Report For Rensselaer County About Their Increasing Medicaid Costs
Question
1) Medicaid costs continue to be a significant burden on counties in NY State. As an expert on Medicaid funding, you have been asked to write a report for Rensselaer County about their increasing Medicaid Costs.
Give a brief overview of how Medicaid works in New York and explain the causes of recent increases. Then suggest two ways they could attempt to reduce costs. This could include an explanation of policy changes they could lobby the state government to enact or examples of successful programs that have been used to reduce costs in other counties or states. Any recommendation you give must be supported by evidence of its benefit.


Solution
Report For Rensselaer
County About Their Increasing Medicaid Costs
How Medicaid Works In New
York
As a Medicaid patient in
New York, one can expect healthcare providers to select the most cost-effective
medication for their medical condition. Generic drugs are almost always
preferred to brand-name pharmaceuticals in certain situations (Medicare Plan
Finder n.p). Any time a doctor recommends a name-brand medication, one needs to
research to see if there are less expensive options. While New York Medicaid
may reimburse brand-name pharmaceuticals, generic alternatives are almost
always cheaper than their brand-name counterparts. In terms of efficacy,
generic medications are nearly identical to their brand-name counterparts. Medicaid
may cover over-the-counter drugs in New York in some cases. A financial order
must be prepared and presented to secure payment, as with prescriptions for
over-the-counter medications and other commodities.
Emergency and
non-emergency medical transportation are provided through the Medicaid program
in New York State. Medical Answering Services and LogistiCare Solutions
administer the transportation service (Medicare Plan Finder n.p). Even
commercial airlines are covered by the insurance policy of the airline company
when it comes to medical emergencies or other emergencies. A Managed Care
option will be available to most Medicaid recipients in New York State. When
comparing plans in a location, one will notice that the most crucial difference
is the network and that it will cost the most. These plans offer the same
essential advantages, but the most excellent option may differ from a neighbor’s
best option and vice versa. It is not clear if all doctors agree with all of
them. A patient needs to ask their current doctor if they are a part of the
Medicaid Managed Care plans in New York State.
Depending on the
provider, services like family planning may be included in some plans but not
others. New York State’s Medicaid program is open to undocumented and temporary
immigrants who meet specific requirements. Low-income immigrants can receive
life-saving emergency care thanks to Emergency Medicaid (Medicare Plan Finder
n.p). To get Medicaid benefits, non-citizens must be legal residents of the
United States. Medicaid enrollees must be treated at all New York hospitals in
an emergency. In a medical emergency, one will not be covered for items like
doctor’s appointments or prescription drugs. In addition, they must meet the
state’s Medicaid income standards to be eligible. As a result of an
application, one’s immigration status will not change, and they will not be
reported to Immigration and Customs Enforcement (ICE). To ensure that one is
covered for the next year in the event of a medical emergency, it is strongly
recommended that they sign up as soon as possible. In an emergency, they might
also go to a hospital and register.
The Causes of Recent
Increases
The rising cost of health
care is becoming a national issue. According to the WHO, the United States
spends roughly twice as much on health care as any other country (New York
State Department of Health n.p). New York City is a microcosm of American
society as a whole. New York’s Medicaid program is the most expensive in the
United States, costing $53 billion per beneficiary (New York State Department
of Health n.p). Five million people are covered, which is roughly double the
national average. New York City’s health care system is, at the very least,
unsatisfactory, even when things are going well. It is no secret that taxpayers
in New York and across the country are not getting their money’s worth out of
the Medicaid system in their state.
Medicaid spending in New
York has increased considerably in recent years, on top of the state’s already
high base amount. Other cost drivers, such as inflation, have also significantly
influenced the program’s overall spending growth, which has risen from $46
billion in April 2007 to the current Medicaid budget, which is above $53
billion (New York State Department of Health n.p). Governor Andrew M. Cuomo,
upon taking office, recognized the seriousness of the issue. Policies, some of
which are expressed as equations, in Medicaid have led to astronomical costs
for the program’s enrollees. According to the New York State Department of
Health n.p, New York’s Medicaid program will become unsustainable unless fundamental
problems are addressed, and spending growth is stopped.
Numerous quality
difficulties plague new York City. New York ranks somewhere in the middle of
the pack in national polls regarding the overall quality of care. However, the
aggregate statistics disguise severe problems, such as New York’s 50th-place
ranking in the country for unnecessary hospitalization (New York State
Department of Health n.p). Race, ethnicity, and socioeconomic class all have a
role in the vast range of health disparities in New York State. In addition to
Medicaid, the health care system is afflicted by similar problems. The most
effective way for New York to decrease its healthcare spending is to enhance
treatment, including proven-effective preventative techniques that improve
general health and reduce health inequities. While the state’s healthcare
system is riddled with inconsistencies, it fails to provide integrated care for
its most complicated and costly groups.
Another cause of the recent
increase is that New York’s Medicaid program and healthcare safety net are
among the most comprehensive. In contrast to other parts of the country, New
Yorkers do not face a shortage of necessities. However, there are too many
people in need of care to be appropriately served. In addition, as in other
states across the country, health inequities exist in New York. For example, society
can close the racial/ethnic health gaps by providing Medicaid coverage to people
of color living in urban and rural locations. However, there is still a lot of
work to fill the gaps in health insurance coverage. With the new MRT action
plan, improvements will be made to the entire state health care system in line
with the triple-aim. Medicaid reform in New York can result in considerable
health care change, given the size of the state’s Medicaid program and the
state’s progressive political tradition. One reason for this is that the state’s
capacity to successfully replicate Medicaid’s efforts in other crucial
state-managed healthcare programs has a substantial role in this outcome. Using
the combined purchasing power of the state’s Medicaid, health insurance market,
and state employees, New York intends to press for a shift in the delivery
system. Before making significant changes to the state’s other social
assistance programs, New York wants to restructure its Medicaid program. Plans
to work with Medicare on sharing data and planning are already underway in New
York, and this will increase the state’s ability to effect change and ensure
that the triple-aim is achieved.
Two Ways They Could
Attempt to Reduce Costs
The Medicaid budget cap
necessitates significant alterations and new approaches. The program’s
effectiveness about its budgetary limits is documented in monthly reports made
public on the Department of Health’s website. As a result of the Commissioner
of Health’s authority to influence the Medicaid expenditure cap, state
authorities and stakeholders have a unique viewpoint on the Medicaid program.
As a result, every policy change must now be evaluated regarding how it may
affect Medicaid funding allocations. It is now possible for the Commissioner of
Health to adjust payment rates and enforce use limits if spending is on the
verge of exceeding the federal government’s ceiling. The Centers for Medicare
and Medicaid Services (CMS), the state of New York, has embraced a triple aim
plan to overhaul the healthcare delivery network.
New York’s Medicaid
redesign program has produced a comprehensive set of performance indicators
that will allow the state to monitor its progress toward achieving the triple
goal. To guarantee that Medicaid reform is supported by broader healthcare
reform is also in New York’s best interest. It is not uncommon to see Medicaid
all around New York (New York State Department of Health n.p). Improvements in
Medicaid payment processes have fostered the growth of Patient-Centered Medical
Homes across the state in recent years. The state of New York is committed to
collaborating with other taxpaying entities on new ideas. It is just one of
several options that the state is ready and able to study to cut total
healthcare expenses while also enhancing public health in the state concerning
healthcare reform.
New York Governor Andrew
Cuomo took a fresh look at the state’s long-standing health care costs and
quality issues. He wanted them to work together, so he invited them to join
him. After signing Executive Order No. 5, Governor Andrew Cuomo’s call for
cooperation in New York was fulfilled. Medicaid stakeholders were brought
together in a spirit of collaboration to reverse the program’s trajectory and
reduce Medicaid spending while enhancing quality (New York State Department of
Health n.p). Over two months, it took the involvement of more than two dozen
stakeholders to develop the MRT recommendations that cut immediate spending. They
made substantial changes to improve health outcomes in the years to come,
including $2.2 billion in the fiscal year 2011–12 (New York State Department of
Health n.p). For more complex situations, the MRT first regrouped into working
groups and then oversaw the implementation of key recommendations made during
the first phase. Using worldwide Medicaid expenditure constraints was a vital
component of the MRT’s Phase 1 approach.
There is a wide range of
treatments covered by Medicaid in New York, ranging from preventative care like
immunizations and physicals to medical supplies and equipment like x-rays or
lab testing to vision and dental care to inpatient stays and prescriptions. In
New York, Medicaid covers the vast majority of dental services. Medically
necessary procedures like extractions to prevent sickness are considered
essential under the provisions of this insurance policy. People with low
incomes who cannot afford dental care for their children benefit from the EPSDT
program. This comprehensive dental care package includes regular dental
examinations and preventive, restorative, and emergency treatment. Orthodontic
treatment for children is also offered in the event of an emergency. This plan
does not cover cosmetic operations such as dental implants, bridges, dentures,
or the like. Medicaid in New York reimburses qualifying patients every two
years for the cost of eyeglasses and contact lenses that are medically necessary.
Prescriptions for eyeglasses purely to improve one’s physical appearance will
be rejected. Both surgical procedures and orthoptic training require prior
approval.
Works
Cited
Medicare Plan Finder. “Everything You Need to Know
About NYS Medicaid.” Medicare Plan Finder, 10 Mar. 2021,
www.medicareplanfinder.com/medicaid-by-state/nys-medicaid. Accessed
25 Apr. 2022.
New York State Department of Health. “A Plan to
Transform the Empire State´s Medicaid Program.” New York State
Department of Health, 2022,
www.health.ny.gov/health_care/medicaid/redesign/mrtfinalreport.htm. Accessed
25 Apr. 2022.




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