By Gary J. Fitzgerald
New York State has recently received some great news: The federal government has agreed to invest $8 billion over five years in New York’s health care system. This “Medicaid waiver” allows New York to keep a share of its Medicaid savings through cost reductions made in recent years.
Upstate health care providers need access to the $8 billion, and that access may be denied. The $8 billion is a product of negotiations between the State Department of Health and the federal Center for Medicare and Medicaid Services.
These agencies need to agree on the terms and conditions of the waiver. Agreement has been made in principle about the intent: to reduce avoidable hospitalizations and to expand primary care. This reform plan is meant to incentivize efforts to provide more community-based services. A key component to determining which health care providers are able to apply for funding is the definition of “safety net.”
The definition of a “safety net” provider has not been agreed to yet. Some groups in New York City are insisting that 40 percent of a hospital’s patients must be Medicaid patients. If this becomes part of the safety net definition, then health care providers across upstate New York will not qualify.
Our organization has proposed definitions of safety net provider that would take into consideration factors that would allow upstate providers to be deemed safety net and therefore eligible for these funds.
Upstate community hospitals have begun the transition – with outpatient services expansion across many communities, and mergers and affiliations in upstate urban centers: Buffalo, Rochester, Syracuse, Utica and the Capital District.
Federal officials have encouraged that the funds be used to reduce hospitalizations and to provide more outpatient care. The federal officials have discouraged using the waiver funds to save hospitals.
Funds should not be used to support providers that have not made a commitment to change and improvement. Waiver funds should allow upstate health care providers to continue their transition and commitment to change.
Upstate New Yorkers deserve affordable, quality, cutting-edge health care. Limiting upstate health care providers’ access to $8 billion in new funding for health care transition is not acceptable. Upstate communities have begun their transition and should be incentivized to continue as safety net providers.
These decisions are being made in Albany and Washington now. Contact your legislators and insist on a fair distribution of the Medicaid waiver funds.
Gary J. Fitzgerald is president of the Iroquois Healthcare Alliance, a trade association representing 53 hospitals and health systems in 31 counties across upstate New York.