Health, Department of

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Agency Web Site: http://www.health.ny.gov/Link to External Website

Mission

The mission of the Department of Health (DOH) is to ensure high quality health services are available to all New Yorkers. The Department is also the principal State agency that administers the Medicaid Program, the New York State of Health (NYSOH) Exchange, and other public health and health insurance programs.

The Department operates health care facilities including Helen Hayes Hospital, four veteran’s nursing homes, and the Wadsworth Centers for Laboratories and Research. In addition, DOH conducts oversight of health professionals and all other health care facilities to ensure that high quality, cost effective, health care alternatives are provided throughout the State.

Organization and Staffing

DOH is headed by a Commissioner, who is appointed by the Governor subject to Senate confirmation. The agency is organized into four major business units: the Office of Public Health; the Office of Primary Care and Health Systems Management; Institutional Management; and the Office of Health Insurance Programs which operates the Medicaid Program. Each of these business units contains multiple divisions and bureaus that work together to carry out DOH’s mission.

The workforce is spread out across the state, encompassing employees of the central office in Albany, four regional offices (located in Syracuse, New York City, Long Island, and Buffalo), the Wadsworth Center Public Health Laboratories, Helen Hayes Hospital (located in Haverstraw) as well as employees of the New York State Veterans’ Homes (located in Oxford, Queens, Batavia, and Montrose).

Budget Highlights

The FY 2019 Executive Budget recommends $153.5 billion for DOH, including $142 billion for Medicaid (represents two year appropriation authority), including $4.3 billion for the Essential Plan, and $7.6 billion for remaining health program spending. This reflects an increase of $5.6 billion from the FY 2018 Budget due to the continuation of two-year appropriations for Medicaid, additional Federal Medicaid funding associated with projected programmatic growth, the Affordable Care Act, and minimum wage increases.

The Budget recommends a workforce of 5,463 full time equivalent employees (FTEs) for the Department. This is an increase of 381 FTEs from the FY 2018 Budget. The increase in FTEs is intended to provide staff to support the seventh year of the phased State takeover of local administration of the Medicaid program (+200), provide operational support for surveillance and certification activities within the Office of Primary Care and Health Systems Management and the Office of Public Health (+142), and to provide necessary resources to review Adult Home applications and provide background checks for Health Home Care Managers serving vulnerable populations (+39).

Major Budget initiatives include:

  • Continuing Medicaid Redesign Team (MRT) reforms. A fiscally-neutral package of new MRT initiatives is proposed to make critical investments in health care delivery and support health care transformation. This package provides continued support to essential community providers, invests in the first 1,000 days of childhood development, enhances Medicaid reimbursement rates for ambulance providers, and grows the assisted living program (ALP) across the State. Investments are balanced by critical modifications to the Medicaid long term care program to ensure access to long term care services and supports for a growing aging population, along with continued controls on Medicaid pharmaceutical costs, and incentives to transition to value based payment arrangements, which fund needed investments in health care delivery and support further health care transformation.
  • Supporting an additional $425 million capital investment for health care providers to transition into fiscally sustainable systems and to support capital projects, debt retirement, working capital and other non-capital needs. Of this amount, $60 million will be reserved for community based providers (i.e., clinics, home care, assisted living programs (ALPs), primary care providers), however, up to $20 million of the $60 million is reserved for expansion of ALPs beds, and $45 million will be reserved for residential health care facilities. This investment will bring the total amount of capital support provided to health care providers for transformation efforts to $3.7 billion over 5 years.
  • Discontinuing Human Services Cost of Living Adjustment payments saving $19.9 million in FY 2019 and $45.4 million in FY 2020.
  • Consolidating 30 public health programs into four pools, achieving $9.2 million in annual savings.
  • Saving $3.2 million in FY 2019 and $11.9 million in FY 2020 in the Early Intervention program through a series of reforms that increase reimbursement from third-party insurers and streamline the evaluation process.
  • Modernizing the American Indian Health pharmacy benefit by implementing a co-pay and formulary structure, mandating generic substitution, and accessing drug discounts and rebates, saving $1.5 million in FY 2019 and $5.9 million in FY 2020.
  • Preserving funding for the Nurse-Family Partnership Program by shifting funding from the Office of Temporary and Disability Assistance to DOH.
  • Continuing support for a life sciences laboratory public health initiative, which will develop life science research, innovation and infrastructure through a joint effort between Empire State Development and the DOH. Building upon the $150 million included in FY 2018, the FY 2019 Budget includes $600 million to support construction of a world-class, state-of-the art life sciences public health laboratory in the Capital District that will promote collaborative public/private research and development purposes.
  • Providing $40 million to continue operational support for the State Health Information Network of New York (SHIN-NY) and continue to develop the All Payer Claims Database (APD).
  • Protecting our children from exposure to lead paint by strengthening lead paint regulations requiring municipalities that administers the Uniform Fire Prevention and Building Code to report inspection and remediation outcome summaries to the Department of Health. Furthermore, State agencies would work together to ensure the inspection of residential and non-residential properties to ensure implementation of lead remediation measures to help reduce the risk of exposure to lead paint.
  • Establishing the Maternal Mortality Review Board to review every maternal death in New York State and develop actionable recommendations to improve care and management.
  • Introducing Comprehensive contraception coverage reform which requires individual and group commercial insurers to cover all FDA-approved contraceptive drugs, devices and products when prescribed by a health care provider, expands access to oral contraception, and allows for 12 months of oral contraception to be dispensed at one time.
  • Extending the storage period for forensic rape kits at hospitals from 30 days to five years to prevent the untimely disposal of evidence, allowing victims more time to heal and make critical decisions.
  • Advancing Stem Cell Research. Increase of $6.5 million in FY 2019 to support awards recommended by the Empire State Stem Cell Board. This $6.5 million is included within the total $600 million commitment to the program. To date, the life time disbursements for the Stem Cell program total $294 million of the commitment.
  • Studing the implications of a regulated marihuana program. The Budget authorizes DOH to study, in consultation with other State agencies, the implications of a regulated marihuana program to determine the health, economic and criminal justice impact, and the consequences to New York State resulting from legalization in surrounding states.

For more information on this agency's budget recommendations located in the Executive Budget Briefing Book, click on the following link:

Program Highlights

Child Health Plus (CHP)

CHP provides comprehensive health coverage for children up to age 19 with family incomes above Medicaid eligibility levels. Like Medicaid, CHP is administered by states with guidance from the Centers for Medicare and Medicaid Services (CMS) and is jointly funded by the Federal government and states. Currently, approximately 350,000 New York children receive health coverage through CHP. Families with incomes below 160 percent of the Federal Poverty Level (FPL) can receive free coverage for their children while families with incomes over that threshold pay on a sliding scale from about $9-$60/month per child. Enrollees in CHP receive primary, preventive, specialty and inpatient care. Federal funding for CHP expired in September with no long-term solution in place. If Congress fails to reauthorize Federal funding, or reduces funding for the Child Health Plus program, the Budget proposes to allow the State to identify the amount of Federal funding that has been withheld, identify available resources or actions, and assess what programmatic changes are necessary to stay within current State funding levels.

Elderly Pharmaceutical Insurance Coverage (EPIC)

The EPIC program provides drug coverage to income-eligible seniors aged 65 and older to supplement out-of-pocket Medicare Part D costs. This program serves approximately 312,000 seniors annually and is financed entirely with State funds, which are offset by revenues from fees paid by EPIC members and rebates from drug manufacturers for generic drugs.

Essential Plan (EP)

The EP provides health coverage for individuals with family incomes between 138 and 200 percent of the Federal Poverty Level (FPL) and for individuals from 0-200 percent FPL who are lawfully present in the United States but do not qualify for Medicaid due to their immigration status. The EP currently has enrollment of approximately 700,000 individuals statewide. The State receives Federal funding through the Essential Plan Trust Fund equal to 95 percent of what would have been provided to EP eligibles had they enrolled in the second lowest cost Silver Plan through the NYSOH. The EP offers a comprehensive package of benefits which include primary, preventive, specialty and inpatient care.

In FY 2018, the President took unilateral Executive action to withhold Cost Sharing Reduction (CSR) payments, threatening low-cost health insurance coverage for income eligible recipients when purchasing a Qualified Health Plan or Essential Plan coverage through the New York State of Health, New York's official health plan marketplace. Despite the Federal withholding of CSR payments, which amount to 25% of the Federal funding for the Essential Plan, the Executive Budget supports this program. In order to offset this loss of funding, the State will utilize EP Medical Loss Ratio (MLR) remittances, reduce reimbursement rates to plan rates to avoid future remittances, and accelerate trust fund to maximize Federal funding.

Medicaid

Medicaid is a means-tested program that finances health care services for over 6 million low-income individuals and long-term care services for the elderly and disabled, primarily through payments to over 80,000 health care providers and more than 85 fully and partially capitated managed care plans. The Medicaid program is financed jointly by the State, the Federal government, and local governments. Eligible services include inpatient hospital care, outpatient hospital services, clinics, nursing homes, managed care, prescription drugs, home care and services provided in a variety of community-based settings (including mental health, substance abuse treatment, developmental disabilities services, school-based services and foster care services).

New York State of Health (NYSOH)

NYSOH serves as a centralized marketplace to shop for, compare, and enroll in a health plan. The health plans offered through NY State of Health are, on average, 55 percent less expensive than those available in 2013, prior to the creation of the marketplace. To date, over 4.1 million New Yorkers have enrolled in coverage through the marketplace. In June 2017, the United States Centers for Disease Control and Prevention reported that the uninsured rate in New York dropped to 4.7 percent, the lowest ever reported in New York State. The Executive Budget includes $694 million in total funding for the operation of the NY State of Health.

Public Health

DOH promotes and protects the health of people and the communities where they live, learn, work, and play. These efforts work to prevent people from getting sick or injured, and promote wellness. DOH staff are responsible for a wide range of public health issues including tracking disease outbreaks, educating the public about the health risks caused by alcohol and tobacco, and developing school nutrition programs. Major programs include:

  • General Public Health Work (GPHW). The GPHW program, authorized under Article 6 of Public Health Law, provides reimbursement to counties and NYC for six mandated core public health services (Family Health, Communicable Disease Control, Chronic Disease Prevention, Community Health Assessment, Emergency Preparedness, and Environmental Health) by providing base grants and covering 36 percent of the remaining net costs.

  • Early Intervention (EI). The EI program provides a comprehensive array of therapeutic and support services to children under the age of three with confirmed disabilities (e.g., autism, cerebral palsy) or developmental delays. The program serves approximately 69,000 children annually and is jointly financed by Federal, State and local governments.
ALL FUNDS
APPROPRIATIONS
(dollars)
Category Available
FY 2018
Appropriations
Recommended
FY 2019
Change From
FY 2018
Reappropriations
Recommended
FY 2019
State Operations 3,666,268,000 3,877,707,000 211,439,000 4,057,948,000
Aid To Localities 143,478,344,100 148,959,050,100 5,480,706,000 150,421,890,000
Capital Projects 687,621,000 627,904,000 (59,717,000) 3,226,195,000
Total 147,832,233,100 153,464,661,100 5,632,428,000 157,706,033,000

ALL FUND TYPES
PROJECTED LEVELS OF EMPLOYMENT BY PROGRAM
FILLED ANNUAL SALARIED POSITIONS
Program FY 2018
Estimated FTEs
03/31/18
FY 2019
Estimated FTEs
03/31/19
FTE Change
Administration
General Fund 924 1,066 142
Special Revenue Funds - Federal 29 29 0
Special Revenue Funds - Other 116 116 0
Capital Projects Funds - Other 31 31 0
Essential Plan
General Fund 6 6 0
Child Health Insurance
Special Revenue Funds - Other 23 23 0
Center for Community Health
Special Revenue Funds - Federal 371 371 0
Special Revenue Funds - Other 79 79 0
Elderly Pharmaceutical Insurance Coverage
Special Revenue Funds - Other 13 13 0
Center for Environmental Health
Special Revenue Funds - Federal 96 96 0
Special Revenue Funds - Other 30 30 0
Capital Projects Funds - Federal 46 46 0
Capital Projects Funds - Other 50 50 0
Office of Health Insurance Programs
Special Revenue Funds - Federal 41 41 0
Office of Primary Care and Health Systems Management
Special Revenue Funds - Federal 85 85 0
Special Revenue Funds - Other 197 197 0
Institutional Management
Special Revenue Funds - Other 1,472 1,472 0
Capital Projects Funds - Other 51 51 0
Wadsworth Center for Laboratories and Research
Special Revenue Funds - Federal 47 47 0
Special Revenue Funds - Other 139 139 0
Medical Assistance Administration
General Fund 662 801 139
Special Revenue Funds - Federal 542 642 100
Medical Marihuana
Special Revenue Funds - Other 32 32 0
Total 5,082 5,463 381

STATE OPERATIONS
ALL FUNDS FINANCIAL REQUIREMENTS BY FUND TYPE
APPROPRIATIONS
(dollars)
Fund Type Available
FY 2018
Recommended
FY 2019
Change
General Fund 919,685,000 875,700,000 (43,985,000)
Special Revenue Funds - Federal 2,404,946,000 2,587,983,000 183,037,000
Special Revenue Funds - Other 341,637,000 414,024,000 72,387,000
Total 3,666,268,000 3,877,707,000 211,439,000

STATE OPERATIONS
ALL FUNDS FINANCIAL REQUIREMENTS BY PROGRAM
APPROPRIATIONS
(dollars)
Program Available
FY 2018
Recommended
FY 2019
Change
Administration
General Fund 136,287,000 152,387,000 16,100,000
Special Revenue Funds - Federal 11,490,000 11,054,000 (436,000)
Special Revenue Funds - Other 19,660,000 19,904,000 244,000
Essential Plan
General Fund 60,326,000 101,671,000 41,345,000
Child Health Insurance
Special Revenue Funds - Federal 138,500,000 138,500,000 0
Special Revenue Funds - Other 3,869,000 12,957,000 9,088,000
Center for Community Health
Special Revenue Funds - Federal 159,747,000 169,747,000 10,000,000
Special Revenue Funds - Other 4,611,000 5,050,000 439,000
Elderly Pharmaceutical Insurance Coverage
Special Revenue Funds - Other 13,224,000 13,250,000 26,000
Center for Environmental Health
Special Revenue Funds - Federal 18,413,000 18,413,000 0
Special Revenue Funds - Other 7,623,000 8,141,000 518,000
Health Care Reform Act Program
Special Revenue Funds - Other 15,300,000 7,370,000 (7,930,000)
Office of Health Insurance Programs
Special Revenue Funds - Federal 625,491,000 625,491,000 0
Special Revenue Funds - Other 6,517,000 6,517,000 0
Office of Primary Care and Health Systems Management
Special Revenue Funds - Federal 20,917,000 21,353,000 436,000
Special Revenue Funds - Other 37,113,000 37,228,000 115,000
Institutional Management
Special Revenue Funds - Other 161,448,000 162,448,000 1,000,000
Wadsworth Center for Laboratories and Research
Special Revenue Funds - Federal 13,401,000 13,613,000 212,000
Special Revenue Funds - Other 62,494,000 62,528,000 34,000
New York State of Health
Special Revenue Funds - Other 0 68,853,000 68,853,000
Medical Assistance Administration
General Fund 723,072,000 621,642,000 (101,430,000)
Special Revenue Funds - Federal 1,416,987,000 1,589,812,000 172,825,000
Medical Marihuana
Special Revenue Funds - Other 9,778,000 9,778,000 0
Total 3,666,268,000 3,877,707,000 211,439,000

STATE OPERATIONS - GENERAL FUND
SUMMARY OF PERSONAL SERVICE APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED
(dollars)
Program Total Personal Service Regular
(Annual Salaried)
Amount Change Amount Change
Administration 103,540,000 16,100,000 101,318,000 16,100,000
Essential Plan 4,015,000 2,179,000 4,000,000 2,164,000
Medical Assistance Administration 94,808,000 8,142,000 94,188,000 8,142,000
Total 202,363,000 26,421,000 199,506,000 26,406,000
STATE OPERATIONS - GENERAL FUND
SUMMARY OF PERSONAL SERVICE APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED CONTINUED
(dollars)
Program Temporary Service
(Nonannual Salaried)
Holiday/Overtime Pay
Amount Change Amount Change
Administration 329,000 0 1,893,000 0
Essential Plan 0 0 15,000 15,000
Medical Assistance Administration 130,000 0 490,000 0
Total 459,000 0 2,398,000 15,000

STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED
(dollars)
Program Total Supplies and Materials
Amount Change Amount Change
Administration 48,847,000 0 6,553,000 0
Essential Plan 97,656,000 39,166,000 9,000 0
Medical Assistance Administration 526,834,000 (109,572,000) 720,000 0
Total 673,337,000 (70,406,000) 7,282,000 0
STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED CONTINUED
(dollars)
Program Travel Contractual Services
Amount Change Amount Change
Administration 1,869,000 0 38,330,000 0
Essential Plan 20,000 0 97,620,000 39,166,000
Medical Assistance Administration 474,000 0 525,460,000 (109,572,000)
Total 2,363,000 0 661,410,000 (70,406,000)
STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED CONTINUED
(dollars)
Program Equipment
Amount Change
Administration 2,095,000 0
Essential Plan 7,000 0
Medical Assistance Administration 180,000 0
Total 2,282,000 0

STATE OPERATIONS - OTHER THAN GENERAL FUND
SUMMARY OF APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED
(dollars)
Program Total Personal Service
Amount Change Amount Change
Administration 30,958,000 (192,000) 14,736,000 (230,000)
Child Health Insurance 151,457,000 9,088,000 48,830,000 314,000
Center for Community Health 174,797,000 10,439,000 62,614,000 (800,000)
Elderly Pharmaceutical Insurance Coverage 13,250,000 26,000 2,275,000 0
Center for Environmental Health 26,554,000 518,000 12,865,000 292,000
Health Care Reform Act Program 7,370,000 (7,930,000) 0 0
Office of Health Insurance Programs 632,008,000 0 74,028,000 0
Office of Primary Care and Health Systems Management 58,581,000 551,000 22,032,000 1,548,000
Institutional Management 162,448,000 1,000,000 103,121,000 0
Wadsworth Center for Laboratories and Research 76,141,000 246,000 14,214,000 (72,000)
New York State of Health 68,853,000 68,853,000 5,373,000 5,373,000
Medical Assistance Administration 1,589,812,000 172,825,000 104,401,000 17,735,000
Medical Marihuana 9,778,000 0 3,670,000 0
Total 3,002,007,000 255,424,000 468,159,000 24,160,000
STATE OPERATIONS - OTHER THAN GENERAL FUND
SUMMARY OF APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED CONTINUED
(dollars)
Program Nonpersonal Service
Amount Change
Administration 16,222,000 38,000
Child Health Insurance 102,627,000 8,774,000
Center for Community Health 112,183,000 11,239,000
Elderly Pharmaceutical Insurance Coverage 10,975,000 26,000
Center for Environmental Health 13,689,000 226,000
Health Care Reform Act Program 7,370,000 (7,930,000)
Office of Health Insurance Programs 557,980,000 0
Office of Primary Care and Health Systems Management 36,549,000 (997,000)
Institutional Management 59,327,000 1,000,000
Wadsworth Center for Laboratories and Research 61,927,000 318,000
New York State of Health 63,480,000 63,480,000
Medical Assistance Administration 1,485,411,000 155,090,000
Medical Marihuana 6,108,000 0
Total 2,533,848,000 231,264,000

AID TO LOCALITIES
ALL FUNDS FINANCIAL REQUIREMENTS BY FUND TYPE
APPROPRIATIONS
(dollars)
Fund Type Available
FY 2018
Recommended
FY 2019
Change
General Fund 38,969,667,100 41,264,377,100 2,294,710,000
Special Revenue Funds - Federal 92,281,863,000 93,458,240,000 1,176,377,000
Special Revenue Funds - Other 12,226,814,000 14,236,433,000 2,009,619,000
Total 143,478,344,100 148,959,050,100 5,480,706,000

AID TO LOCALITIES
ALL FUNDS FINANCIAL REQUIREMENTS BY PROGRAM
APPROPRIATIONS
(dollars)
Program Available
FY 2018
Recommended
FY 2019
Change
Administration
General Fund 266,000 266,000 0
AIDS Institute
General Fund 103,495,000 103,255,700 (239,300)
Essential Plan
General Fund 431,367,000 386,218,000 (45,149,000)
Special Revenue Funds - Federal 3,746,597,000 3,786,717,000 40,120,000
Child Health Insurance
Special Revenue Funds - Federal 1,150,269,000 1,352,941,000 202,672,000
Special Revenue Funds - Other 482,087,000 482,777,000 690,000
Center for Community Health
General Fund 653,726,100 595,526,400 (58,199,700)
Special Revenue Funds - Federal 904,117,000 904,117,000 0
Special Revenue Funds - Other 5,665,000 5,665,000 0
Elderly Pharmaceutical Insurance Coverage
Special Revenue Funds - Other 132,580,000 132,580,000 0
Center for Environmental Health
General Fund 6,512,000 5,017,000 (1,495,000)
Special Revenue Funds - Federal 3,687,000 3,687,000 0
Special Revenue Funds - Other 9,560,000 9,560,000 0
Health Care Reform Act Program
Special Revenue Funds - Other 382,100,000 1,366,461,000 984,361,000
Office of Health Insurance Programs
General Fund 22,111,000 20,677,000 (1,434,000)
Special Revenue Funds - Federal 320,000,000 320,000,000 0
Special Revenue Funds - Other 2,930,000 2,930,000 0
Office of Primary Care and Health Systems Management
General Fund 10,882,000 30,568,000 19,686,000
Special Revenue Funds - Federal 1,000,000 1,000,000 0
Special Revenue Funds - Other 12,560,000 12,560,000 0
Wadsworth Center for Laboratories and Research
General Fund 907,000 0 (907,000)
Special Revenue Funds - Federal 3,682,000 3,682,000 0
Special Revenue Funds - Other 11,080,000 11,080,000 0
Medical Assistance Administration
General Fund 1,377,500,000 1,377,500,000 0
Special Revenue Funds - Federal 1,441,300,000 1,441,300,000 0
Medical Assistance
General Fund 36,362,901,000 38,745,349,000 2,382,448,000
Special Revenue Funds - Federal 84,711,211,000 85,644,796,000 933,585,000
Special Revenue Funds - Other 11,188,252,000 12,212,820,000 1,024,568,000
Total 143,478,344,100 148,959,050,100 5,480,706,000

CAPITAL PROJECTS
ALL FUNDS FINANCIAL REQUIREMENTS BY PROGRAM
APPROPRIATIONS
(dollars)
Comprehensive Construction Program Available
FY 2018
Recommended
FY 2019
Change Reappropriations
FY 2019
All Payers Claims Database
Capital Projects Fund 10,000,000 10,000,000 0 0
Capital Restructuring Program for Health Care and Related Facilities
Capital Projects Fund - Authority Bonds 0 0 0 1,189,313,000
Health Care Facility Transformation Program
Capital Projects Fund - Authority Bonds 500,000,000 425,000,000 (75,000,000) 1,700,000,000
IT Initiatives Program
Health Care IT Capital 10,000,000 10,000,000 0 0
Laboratories and Research
Capital Projects Fund 8,000,000 8,000,000 0 46,061,000
Capital Projects Fund - Authority Bonds 0 0 0 802,000
Maintenance and Improvements of Existing Institutions
Capital Projects Fund 52,621,000 67,904,000 15,283,000 40,970,000
Statewide Health Information Network For New York
Capital Projects Fund 30,000,000 30,000,000 0 0
Water Resources
Federal Capital Projects Fund 77,000,000 77,000,000 0 249,049,000
Total 687,621,000 627,904,000 (59,717,000) 3,226,195,000

Note: Most recent estimates as of 01/16/2018

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