Health, Department of

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Agency Web Site: https://www.health.ny.gov/

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 2020 Executive Budget recommends $160 billion for DOH, including $148 billion for Medicaid (represents two year appropriation authority), including $5 billion for the Essential Plan, and $7 billion for remaining health program spending. This reflects an increase of $8 billion from the FY 2019 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 5,616 full time equivalent employees (FTEs) for the Department. This is an increase of 154 FTEs from the FY 2019 Budget. The increase in FTEs is intended to provide staff to support the eighth year of the phased State takeover of local administration of the Medicaid program (+101), Behavioral Health Parity (+8), support for reducing blood lead levels (+28), health costs associated with birth-related neurological injuries through the Medical Indemnity Fund (MIF) (+10) and increased operation support for the Opioid Stewardship Fund (+7).

Major Budget initiatives include:

• Continuing Medicaid Redesign Team (MRT) reforms. A fiscally-neutral package of new MRT initiatives is proposed to make critical modifications to the Medicaid program. The Executive Budget provides continued support to essential community providers and ambulance providers through enhanced Medicaid reimbursement rates as well as expanding coverage for applied behavioral analyst services for children. Investments are balanced by critical modifications to the Medicaid long term care program to ensure continued long term care services and supports for a growing aging population, along with continued controls on Medicaid pharmaceutical and transportation costs, modifications to prevent waste in the Medicaid program, reforms to the Health Homes program, and Medicare Part B payment reform for dual eligible enrollees.

• Continuing capital investments for health care providers to transition into fiscally sustainable systems and to support capital projects, debt retirement, working capital and other non-capital projects. The total amount of capital support provided to health care providers for transformation efforts to $3.8 billion.

• Reducing General Public Health Work reimbursement to New York City from 36 to 20 percent, saving $27 million.

• Implementing measures to help reduce the risk of exposure to lead paint.  This includes lowering the acceptable blood lead level from 15 pg/dl to 5 pg/dl to continue the State’s goal of eliminating sources of lead exposure before a child is injured. the Budget commits an additional $9.4 million annually to help combat child lead exposure.  

• Increasing reimbursement rates for services furnished to eligible infants and toddlers in the Early Intervention program and their families by licensed physical therapists (PT), occupational therapists (OT), and speech-language pathologists (SLP) by 5 percent. Implementing broader tobacco control policies, including raising the minimum sales age for tobacco products from 18 to 21, ending the sale of tobacco products in pharmacies, banning the sale of flavored e-cigarette liquids, requiring e-cigarettes to be sold only through licensed tobacco retailers, restricting available discounts provided by tobacco manufacturers and retailers, and restricting tobacco product display, and tax electronic liquid.

• Continuing $750 in 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. This initiative positions New York to attract private investment and jobs, a key component of the life science initiative.

• 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 implementing measures to help reduce the risk of exposure to lead paint. This includes lowering the acceptable blood lead level from 15 μg/dl to 5 μg/dl to continue the State’s goal of eliminating sources of lead exposure before a child is injured.

• 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.

• Securing women’s access to reproductive health options by codifying the Supreme Court’s Roe v. Wade decision and subsequent rulings into State law.

• Providing an additional $60 million for Disproportionate Share Hospital (DSH) payments to the three State University of New York teaching hospitals. These hospitals are at SUNY Upstate Medical Center, SUNY Downstate Medical Center, and Stony Brook University Hospital.

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

Briefing Book – Health Care (PDF)

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, nearly 400,000 New York children receive health coverage through CHP. Families with incomes below 160 percent of the Federal Poverty Level (FPL) 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 the Children's Health Insurance Program (CHIP) has been reauthorized through FFY 2027

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 326,000 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.

The Affordable Care Act (ACA) provides a phase-out of the Medicare Part D coverage gap. The closure of the coverage gap will result in Medicare Part D picking up a larger share of program costs that were previously covered in EPIC.

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 743,000 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-eligible enrollees 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 percent of the Federal funding for the Essential Plan, the Executive Budget supported this program. However, recent actions by the Trump Administration in response to litigation brought by the State will allow the State to recoup some of the withheld EP funding through changes to the reimbursement methodology. The Executive Budget continues to reflect support for the EP program.

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 75 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)

In 2013, in accordance with the Federal Affordable Care Act, the Governor issued Executive Order #42 to establish a New York Health Benefit Exchange. The Exchange – NY State of Health – 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. Since its inception in 2014, the NY State of Health has enrolled more than 4.7 million New Yorkers in affordable health coverage. The number of uninsured New Yorkers has declined by nearly one million. Between 2013 and 2018 the rate of uninsured in the State has declined to 7.0 percent among the non-elderly population according to the Urban Institute. The Executive Budget includes $575 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, except for New York City, which is proposed to be reimbursed at 20 percent.

• 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.

Note: Most recent estimates as of 1/15/2019