Budget likely will include portion of Medicaid Redesign package

ALBANY - Senate and Assembly lawmakers say their budget proposals would largely implement the recommendations of Gov. Andrew Cuomo's Medicaid Redesign Team, but there are key differences that have to be worked out in medical malpractice, prescription drugs and other areas.

Dozens of recommendations from the MedicaidRedesign Team's recent report to the governor were included in Cuomo's amended budget proposal. Not everything is expected to make it into the 2011-12 budget intact, and the Assembly and Senate have staked out their negotiating positions.

"I think it's fair to say both of us are largely on board with the MRT package and both of us and our conferences disagree on some things," said Assembly Health Committee Chairman Richard Gottfried, D-Manhattan, said Wednesday.

Senate Health Committee Chairman Kemp Hannon, R-Nassau County, said the Medicaid proposals make this year different from previous ones.

"I think the innovation there was something new. We hadn't seen that before," he said. "It used to be we'd just be fighting over numbers, so they have opened up the arena substantially."

One of the most controversial recommendations is to place a $250,000 cap on damage awards for pain and suffering and set up an indemnity fund for infants with neurological impairments.

The Assembly opposes the cap and wants to amend the proposal for the indemnity fund by setting up a work group that would advise hospitals on how to reduce birth-related neurological injuries and approve obstetrical patient-safety programs.

The Senate supports the proposal but wants to change it to include medical-malpractice reforms, such as supplementing premiums in hospitals that implement comprehensive patient-safety measures.

AARP and other patient-rights groups, including Citizen Action and the New York Public Interest Research Group, oppose the cap. The New York State Medical Society support it.

"This proposal will hurt many consumers, particularly seniors, by making it much harder for these individuals to obtain justice in the courts when they have been injured by the negligence of others," Lois Wagh Aronstein, AARP New York director, said in a statement.

Lawmakers adopted the budget resolutions Tuesday. Conference committees to work out differences between the two houses' budgets have begun to meet. The budget is due by the April 1 beginning of the 2011-12 fiscal year.

The governor's budget also includes a cap on Medicaid spending and limits on future growth, rate reductions and an end to automatic rate increases. Nearly five million New Yorkers receive Medicaid, a health-care program for the poor.

The proposals would save $2.3 billion. New York spends more than twice the national average on Medicaid on a per capita basis.

Home-care workers may not get their wage increases, which was a key factor in getting 1199 SEIU United Healthcare Workers East to support the Redesign Team's recommendations. The plan calls for boosting the pay of direct-care workers over three years.

The Assembly includes this in its budget, but the Senate does not.

Kevin Finnegan, political director for 1199, said the union is disappointed but hopeful the budget will include the increases. Roughly 50,000 workers would be affected, he said.

"It's a one-house bill," he said of the Assembly budget. "They're not locked into it. There's a lot of positioning and posturing that goes into one-house bills. People are taking bargaining positions."

The New York Association of Homes and Services for the Aging opposes the pay hikes, saying they could lead to layoffs.

Other groups are lobbying against a proposal that would give the state, and not physicians, the final say regarding prior-authorization of brand drugs that aren't on Medicaid's preferred-drug list. It would require prior authorization to prescribe medication for people with lupus, HIV/AIDS, mental illness, kidney disease and other chronic illnesses.

"Those with mental illness who are unable to access the most appropriate, clinically indicated psychiatric medication experience higher rates of emergency department visits, hospitalizations and other health services," said Matthew Shapiro of the National Alliance on Mental Illness in New York.

The Senate budget resolution rejects that element in the governor's budget and would give the provider the final say. The Assembly's does not, but the repeal of so-called "physician prevails" would be in place for one year, Gottfried said.

The New York Nurses Association is running an advertising campaign that urges lawmakers and the governor to "go slower" on implementing the Redesign Team's proposals.

"Our members, who take care of patients every day, want to remind our legislators that the state budget isn't just numbers on paper, but represents resources that affect the care and well-being of real people," Tina Gerardi, CEO of the group, said in a statement.

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