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 2021 Executive Budget recommends $88.5 billion for DOH, including $76.7 billion for Medicaid, including $5.3 billion for the Essential Plan, and $6.5 billion for remaining health program spending. This reflects a decrease of $71.7 billion from the FY 2020 Enacted Budget due to the discontinuation of two-year appropriations for Medicaid.

The Budget recommends a workforce of 5,637 full time equivalent employees (FTEs) for the Department. This is an increase of 22 FTEs from the FY 2020 Budget. The increase of 22 FTEs is driven by support for the ninth year of the phased State takeover of local administration of the Medicaid program (+75), additional staff for the purposes of testing and regulating industrial hemp and CBD products (+20), and a shift from local support to state operations of the Family Planning program (+10). These increases are offset by FTE reductions from main office attrition (-67) and movement of 16 FTEs to the Office of Cannabis Management for the medical cannabis program (-16).

Major budget initiatives include:

• Reforming Medicaid through the Medicaid Redesign Team (MRT) II initiative. The FY 2021 Budget reconstitutes the MRT, bringing stakeholders, who bring experience as health care providers, and representatives from the Legislature back to the table to find solutions that will once again contain spending growth so that this critical program that provides health care to more than 6 million New Yorkers remains financially sustainable for the future.

The 2020 MRT must report back before the April 1 deadline to enact a Budget with a plan to deliver $2.5 billion in recurring savings. The Governor is directing the members of MRT II to develop a plan that doesn’t rely on local governments as a funding sources and has minimal impact on beneficiaries. Instead, MRT II must once again find solutions through industry efficiencies and/or by relying on new resources provided by the industry itself.

• Requiring Enhanced Local District Medicaid Controls. Although the State has shouldered the over $20 billion cost of local district relief in Medicaid, local governments are responsible for determining eligibility and administering certain programs. Because local governments are no longer fiscally responsible for the cost growth, there is no longer a financial incentive for them to control costs, a factor that has led to the dramatic increases in overall Medicaid spending growth since the State took over the local share of Medicaid spending growth.

Local governments administer and monitor programs and determine eligibility and they must also find efficiencies and savings, as well as and rooting out waste, fraud and abuse in our system. Because the State takeover of 100% of the growth in local Medicaid costs was intended to assist counties and staying within the two percent property tax cap, the Budget ensures that counties that adhere to the two percent property tax growth cap continue to receive full benefit of the State takeover of Medicaid spending growth while penalizing those that don't by limiting the State’s financing of growth in Local Medicaid expenditures to 3 percent annually. Additionally, the Commissioner and the Director of the Division of the Budget are empowered to access any data necessary to manage the Medicaid program.

• 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.

• Implements a comprehensive nicotine vaping agenda to reduce nicotine and tobacco use in New York. This includes addressing the public health crisis of youth nicotine vaping and the use of electronic cigarettes by banning the sale of flavored nicotine products.

• 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).

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 420,000 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

The Budget includes savings associated with claiming enhanced Federal funding through a health services initiative for non- Medicaid programs that support children.

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 335,000 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 (ended January 2020). 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 over 770,000 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 50 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 4.8 million New Yorkers in affordable health coverage. The number of uninsured New Yorkers has declined by over one million. Between 2013 and 2018 the rate of uninsured in the State has declined to 5.6 percent among the non-elderly population according to the Centers for Disease Control and Prevention. The Executive Budget includes $519 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 New York City 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 the FY 2020 Budget reduced to 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.

• The Budget includes a series of reforms designed to ensure commercial insurers pay their share including: market conduct examinations led jointly by DOH and DFS; clarifications of benefit coverage that specify coverage rules, including that insurers cannot offset coverage limits for therapies; implements new regulations on network adequacy; updates billing codes to allow for more accurate billing; and streamlines provider agreement process to accept existing Insurance Plan credentialed/approved practitioners as approved EIP

Note: Most recent estimates as of 01/29/2020

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