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 five major business units: the Office of Public Health; the Office of Primary Care and Health Systems Management; Institutional Management; the New York State of Health; 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 2024 Executive Budget recommends $215.6 billion for DOH, including $196.4 billion for Medicaid (representing the two-year appropriation authority), $8.9 billion for the Essential Plan, and $10.3 billion for remaining health program spending.

The Budget recommends a workforce of 6,057 full time equivalent employees (FTEs) for the Department. This is an increase of 39 FTEs from the FY 2023 Budget. The increase of 39 FTEs is associated with base adjustment from legislative impacts (19), and additional resources to establish the Division of Vaccine Excellence (20).

Major budget initiatives include:

• Continuing the State Takeover of Local Medicaid Costs. In FY 2024, the State will assume nearly $5.5 billion in costs that would have otherwise been incurred by localities. This is an annual multi-billion-dollar relief package to the localities that continues to grow by billions of dollars, annually. Since 2015, the counties have saved $38.7 billion due to the local takeover.
• Expanding Medicaid Coverage of Preventative Care. The Budget includes $53.7 million in FY 2024 growing to $104.1 million in FY 2025 to expand Medicaid coverage of preventative health services. The Budget supports critical preventative care for Medicaid enrollees that will help improve population health and reduce hospitalizations, including: increasing supportive housing funding; expanding Adverse Childhood Experiences screening; expanding coverage for nutritionist services; expanding coverage for therapies; increasing dental care rates; increasing rates for children’s vaccine administration; expanding coverage of spinal muscular atrophy prenatal screening; expanding screening for social determinants of health; and expanding coverage for Doula services.
• Increasing Supportive Housing Funding. The State will invest $15 million in FY 2024 and $30 million in FY 2025 to provide additional housing units to persons who are currently housing insecure or in skilled nursing facilities and need permant housing.
• Expanding the Medicaid Buy-in Program. The Budget invests $60 million annually to provide an expansion to the Medicaid Buy-in program so more New Yorkers with disabilities can work and still qualify for Medicaid coverage by removing the age limit, and increasing resource limit to $300,000 and the income limit for eligibility from 250% of the Federal Poverty Level (FPL) to 2,250% of the FPL.
• Expanding Access to Primary Care. The Budget invests $46 million in FY 2024, growing to $104.4 million, to support evidence-based interventions to improve access to primary care for Medicaid enrollees and reduce preventable hospitalizations and emergency room visits by:
  • Increasing overall Medicaid reimbursement rates for all primary care, and specifically for nurse practitioners, who are critical providers of primary care;
  • Expanding Medicaid coverage of primary and urgent care within the shelter system, which is expected to help tens of thousands of New Yorkers facing housing insecurity to access care;
  • Expanding Medicaid coverage of community health workers to help hundreds of thousands of New Yorkers navigate the health and social services systems;
  • Increasing Medicaid reimbursement rates for school-based health centers, which increase access to primary care and other health services for children and their families;
  • Expanding Medicaid screenings for Hepatitis C and Congenital Syphilis Third Trimester for all pregnant persons; and,
  • Supporting several initiatives to promote the integration of primary and mental health care, including allowing Medicaid reimbursement for additional types of licensed mental health providers in community health centers, establishing a working group on integrated care, and relaxing licensure restrictions for dually-licensed hospitals, outpatient clinics, and behavioral health clinics.
• Investing in Provider Reimbursement. The Budget provides a 5 percent rate increase to hospitals, nursing homes and assisted living providers, a total investment of $379 million State share, inclusive of $157.5 million to enable New York’s nursing home staff to provide high-quality care to residents.
• Preserving the Safety Net. The Executive Budget maintains the State’s commitment to supporting financially distressed health care facilities. Additionally, the Executive Budget establishes the definition of Rural Emergency Hospitals to align with a new provider type in Federal statute, which will allow smaller hospitals to maintain core operations that preserve services and access in the community while gaining access to Federal funding streams. In order to better target state funding to high need facilities, the State continues the implementation of the Medicaid Redesign Team II (MRT II) recommendations to reduce the State funded portion of the Voluntary Indigent Care Pool (ICP). Additionally, The Budget makes changes to insurance law related to site of service review to ensure coverage of services provided at hospital-based outpatient clinics.
• Financing SUNY Hospital Uncompensated Care. The Budget provides an additional $72 million, growing to $106 million for Disproportionate Share Hospital (DSH) payments for under and uncompensated care provided by 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.Long Term Care Actions.
• Integrating Managed Long Term Care Plans and Other Managed Care Reforms. The Budget provides authority for DOH to reform Managed Long Term Care Partial Capitation plans and the option to competitively procure Managed Care Organizations participating in all managed care product lines. Partial capitation reform will produce $65 million in savings, beginning in FY 2025. The Budget also makes the following managed care reforms:
• Requiring Plans to Pay a Claim as Billed by a Provider and Limit the Reviews of Scope in Good Faith Medical Necessity Disputes. When a payer questions the medical necessity of the services, the claim will be reviewed by a joint committee composed of clinicians representing both the payer and the general hospital and if the dispute prevails, then ultimately the claim will be determined by an independent third party. The Budget invests $7.7million in FY 2024 and $31.8 million in FY 2025.
• Increasing the Medical Loss Ratio [CM(1] [BE(2] (MLR) From 86 Percent to 89 Percent for All Plans. The MLR is the proportion of premium revenues managed care plans must spend on clinical services. Increasing the MLR will require managed care plans to spend more of their premium revenue on medical care, or remit the difference to the State. This proposal will result in savings of $67 million in FY 2025.
• Discontinuing Supplemental Funding for Managed Care Quality Pools. This proposal will provide savings of $111.8 million State-share in FY 2024 and FY 2025.
• Recalibrating the Health Homes Program. The Health Home program was conceived as a model to support stabilization of health and social needs, it has become a program geared toward stabilization and maintenance. With provision of skill building support and safe discharge planning, this proposal will graduate out the low and medium-acuity individuals who have had long-term enrollment in the program. This action will result in savings of $30 million in FY 2024 and $70 million in FY 2025.
• Reforming Medicaid Pharmacy. The Budget implements the pharmacy benefit transition from managed care to fee-for-service to improve transparency, streamline administration and maximize the State’s ability to leverage pharmacy rebates. The Budget will re-invest savings achieved from accessing drug rebates in 340B providers including Ryan White Clinics, Federal Qualified Health Centers, and hospitals. The reinvestments will backfill the loss of 340B revenues so these facilities are made whole and can continue providing care to vulnerable populations.

Additionally, the Budget enhances pharmacy oversight by eliminating “prescriber prevails” and coverage for certain over‐the‐counter products.

Health Delivery System Reform: The Budget makes a series of investments to strengthen and stabilize the State’s healthcare delivery system as follows:

• Investing in Statewide Health Care. The FY 2024 Executive Budget proposes a new $1 billion in capital investments through funding a new round of the Statewide Health Care Facility Transformation Program, which includes $500 million dedicated to enhancing NYS healthcare IT infrastructure. These funds will support facility transformation projects for eligible health care providers, and spur investment in advanced clinical technologies, cybersecurity tools, and other technological upgrades to improve quality of care, patient experience, accessibility, and efficiency.

• Allowing Healthcare Providers to Do More. The State Budget seeks to address the healthcare workforce shortage in New York, which has led to access and quality of care problems for New Yorkers by providing flexibility to allow healthcare providers to do more (expanding their “scope of practice”) under their licenses. Making these flexibilities permanent and expanding scope further will help alleviate the shortage, by continuing to allow the current workforce system to provide more care.

• Reforming Approval Processes of Healthcare Projects. The FY2024 Executive Budget will amend the Certificate of Need (CON) process, resulting in an estimated $1 million per year in revenue. This increase in revenue will be used towards a $2.1 million investment to improve the CON application process.

• Revitalizing Emergency Medical Services (EMS) and Medical Transportation. The FY 2024 Executive Budget provides various investments to enhance EMS statewide. As a result, the FY 2024 Executive Budget provides $7.6 million in increases to the EMS special revenue fund, which is anticipated to increase to $20.1 million in FY 2025 before reaching the full annual value of the investment of $26.3 million in FY 2026. Capital equipment resources will also be provided to enhance the statewide fleet of EMS vehicles, including ambulances and fly-cars, as well as non-transport treatment vehicles.

• Strengthening New York’s Public Health Emergency Readiness Capacity: The FY 2024 Executive Budget will commit additional staff resources to work with other state agencies, as well as key local and national partners, to build more robust emergency response plans, conduct emergency response training, and ensure appropriate stockpiling of medical equipment and supplies.

• Modernizing our Health Reporting Systems. The FY 2024 Executive Budget will support the replacement of the State's outdated health care reporting infrastructure with a nation-leading health monitoring and surveillance system to inform targeted and appropriate responses to public health crises and to drive broader health care insights. Investments under this initiative will include a new $30 million Capital program for an electronic health record connectivity program, additional Capital dollars for the Statewide Health Information Network for New York (SHIN-NY), a recurring Capital investment in the capacity for hospitals to have direct access, and additional operating fund investments for the Hospital Electronic Response Data System (HERDS).

• Strengthening Regional Health Department Infrastructure. The Executive Budget supports ensuring regional offices are more integrated into public health policy making and that they prioritize the needs of local health department.

• Rebuilding the Wadsworth Laboratories: Governor Hochul will provide $967 million in additional funding to complete the consolidation of Wadsworth’s five unconnected sites located throughout the greater Albany area into one new, state-of-the-art facility on Albany’s W. Averell Harriman Campus by 2030.

Improving Health Outcomes. The Budget makes a series of investments to support a healthier New York, with better outcomes and improved health equity, including:

• Leading the Way for a Tobacco-Free Generation. The FY 2024 Executive Budget includes proposals to increase the cigarette tax from $4.35 to $5.35 per pack and to prohibit the sale of all flavored tobacco products. These actions are projected to reduce the number of young people smoking cigarettes by nine percent, prevent 22,000 youths from becoming adult smokers, and prevent premature deaths caused by smoking. The anticipated loss of tobacco and vaping product revenue is expected to be $133 million in FY 2024 and $255 million annually in the out-years.

• Protecting Reproductive Rights and Access. The Budget seeks to stabilize and strengthen New York’s reproductive health system by protecting personal data and improving access to services.

• Continuing Investment in Abortion Services. The FY 2024 Executive Budget provides recurring, annual support of $25 million to continue to expand abortion provider capacity within the State help and ensure access for patients seeking abortion care in New York State.

• Safeguard Abortion Access Through Data Privacy. The Budget seeks to protect the personal data, including location history and search history, of anyone who seeks abortion care in New York. Companies and law enforcement agencies headquartered in New York will be prohibited from sharing abortion data, such as geolocation data, or search histories with out of state law enforcement. Additionally, digital advertisers would be prohibited from targeting visitors to health care facilities, including abortion clinics.

• Implementing Over-the-Counter Contraception Access. The Budget expands access to reproductive health services by allowing pharmacists to directly prescribe and order hormonal contraceptives and emergency contraceptive drug therapy.

• Increasing Reimbursement Rates for Reproductive Health Providers. The Budget increases Medicaid reimbursement rates to fairly compensate reproductive health providers such as family planning clinics and abortion care providers.

• Addressing Childhood Lead Poisoning in High-Risk Areas Outside of NYC: The FY 2024 Executive Budget will invest $39.8 million to reduce the risk of lead exposure in rental properties. Rental units built before 1980 will be required to be assessed on a three-year cycle to try and identify any hazards that may pose an imminent risk to children. To help assist landlords, State funding will be provided to defray the costs of inspections as well as to support renovations when dangerous conditions are identified.

• Ending Preventable Epidemics. The FY 2024 Executive Budget includes proposals requiring third trimester screening during pregnancy to prevent a rise in future congenital syphilis cases and to expand the screening for Hepatitis C for more New Yorkers, including all pregnant persons.

• Continuing Investments for Sexuality-Related Programs and the LGBTQ+ Community. The FY 2024 Executive Budget continues the prior year action of a $12 million annual investment in sexuality-related programs, which includes $2 million dollars of funding to support the programs of the Lorena Borjas Trans Wellness and Equity Fund.

• Assisting Small and Underserved Communities in Protecting Drinking Water Quality. The FY 2024 Executive Budget provides $10 million for the creation of a new program under the Department of Health which will assist small and underserved communities in meeting NYS's first-in-the-nation standards for drinking water quality.

• Ensuring Access to Aging Services and High-Quality Long-Term Care. Last year, Governor Hochul directed the creation of the first-ever statewide Master Plan for Aging to ensure New Yorkers can age with dignity and independence wherever they choose. The Budget will:

• Supporting for Family Caregivers. Provide respite care for high-need family caregivers, granting relief for those who oversee care of their loved ones, through an increased investment of $6.2 million.

• Providing for Care Teams. Invest $1 million in care teams to provide care for low- income adults in their home, helping to ensure New Yorkers can age in place.

• Enhancing Quality Reporting and Accredidation for Assisted Living Residences. Establish quality reporting and accreditation for assisted living residences, and implement quality improvement initiatives in nursing homes to promote transparency and make it easier for New Yorkers to make informed choices, through $525,000 worth of additional resources.

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, over 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. The FY 2023 Enacted budget expanded benefits under CHP to align with Medicaid. These services include Children and Family Treatment and Support Services (CFTSS). Children’s Home and Community Based Services (HCBS). Assertive Community Treatment (ACT), and Residential Rehabilitation for Youth (RRSY).

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 313,000 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 program has been extraordinarily successful, with nearly 800,000 New Yorkers enrolling at the end of FY 2020. 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.

The Executive Budget makes significant investments to the Essential Plan that would reduce consumer costs and help to provide increased revenue to providers, including hospitals. These actions include:

• Submitting a waiver to the Federal Centers for Medicare and Medicaid Services (CMS) that would allow the State to expand affordable coverage through the EP Program by raising the Federal Poverty Limit cap from 200 percent to at least 250 percent.

• Increasing reimbursement rates for providers by aligning rates across all tiers of EP coverage.

• Reducing consumer cost sharing to move closer to Medicaid parity.

• Expanding the existing quality pool and funding new grants to incentivize plans investments in mental health and social services addressing social determinants of health.

• Increasing the plans medical loss ratio from 85 percent to 86 percent to ensure more money is spent on medical services.

• Expanding the pregnancy/postpartum benefit to all women with incomes of 138 percent of the FPL to 250 percent FPL and provide wraparound coverage to support any benefits or cost-sharing that are currently covered in Medicaid.

Medicaid

Medicaid is a means-tested program that finances health care services to approximately 7.9 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 45 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 nearly 6.9 million New Yorkers in affordable health coverage. The number of uninsured New Yorkers has declined by 1.3 million since 2010. The Budget includes $584 million in total funding in FY 2024 for the operation of NYSOH.

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 is 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 71,000 children annually and is jointly financed by Federal, State and local governments.

Note: Most recent estimates as of 02/01/2023