Among the recommendations is letting the state Health Department set payment rates.
View full sizeNew York state Lt. Gov. Richard Ravitch walks into the State Office Building in Syracuse for meetings in this photo from Oct. 14, 2009. Ravitch released a report Monday calling for an overhaul of the Medicaid program to reduce fraud, waste and duplication.ALBANY, N.Y. (AP) — Lt. Gov. Richard Ravitch issued a plan Monday to cut the fraud, massive waste and duplication that he sees in New York’s $50 billion-a-year Medicaid system.
The plan would bite into a sprawling health care coverage that consumes a third of the state’s budget and now serves nearly one in every four New Yorkers. “For reasons of history, bureaucratic inertia, and politics, New York’s Medicaid program is not administered in the most rational or cost-effective manner,” Ravitch said in the report.
Ravitch makes several recommendations, including the transfer of setting rates paid to physicians and hospitals from the Legislature to the Health Department, with an independent commission to advise the governor and Legislature on policy. He also would end payments into Medicaid by cash-strapped counties.
The report is part of a major long-term fiscal analysis to fix New York’s finances that Ravitch was asked to take on by Gov. David Paterson. It is the result of months of work by Ravitch, whose fiscal acumen is widely respected in Albany and who was a key player in saving New York City from bankruptcy in the 1970s when he was recruited for the task from the private sector.
Ravitch called the Medicaid system unwieldy and said it serves “contradictory goals and provides perverse incentives.” “As a result, it is ill-equipped to control costs or to benefit from the federal health care reform,” he said.
He said the state won’t be able to adequately manage the increase of New Yorkers who would qualify for government health care under the federal law President Barack Obama signed in March. Effective in 2014, the federal law would require Americans to carry coverage, with exceptions for financial hardship. The government would help pay the premiums for millions of people.
Leaders of the Assembly and Senate, whose chambers would have to approve many of Ravitch’s proposals, had no immediate comment. Critics call New York’s Medicaid services a Cadillac plan because it includes some dental and vision coverage and some transportation.
Ravitch and Paterson expect to meet a second time on the plan this week. The governor has backed some of the recommendations, including reducing malpractice awards. The recommendations also include:
• Consolidating administration.
• Creating a coordinated strategy for long-term care, the chronically ill and care for the developmentally disabled to improve treatment and reduce costs.
• Increasing state prevention efforts against drug and alcohol abuse, heart disease and childhood obesity.
• Setting a higher priority on increasing New York’s federal reimbursement to better reflect the state’s poverty, which in a formula is offset by its wealthiest residents.
• Reducing malpractice premiums for health care providers, promoting patient safety, and creating a cap on non-economic damages.
• Re-evaluating the common “spend down” practice in which people reduce their assets to qualify for Medicaid-paid care intended for the needy.