NEW YORK NURSE: March 2011
by Karen A. Ballard, MA, RN, FAAN, President
In his State of the State address, Governor Andrew Cuomo announced he’d issued an Executive Order to redesign New York’s Medicaid program. The Governor observed, “It is of compelling public importance that the state conduct a fundamental restructuring of its Medicaid program to achieve measurable improvement in health outcomes, sustainable cost control, and a more efficient administrative structure.”
It is a challenge and an awesome responsibility to be a representative of nursing on the Medicaid Redesign Team charged with finding cost savings within the system while preserving quality care.
Medicaid is the state’s single largest insurer of healthcare. Everyone knows the Medicaid program is in financial difficulty. The state spends almost half its budget on health care and education. With a $10-billion budget gap, the administration has made it clear that both sectors must contribute efficiencies to closing the deficit. The Medicaid program’s inferior showing in quality indicators must also improve. Practitioners and providers are challenged to provide better care with fewer fiscal resources.
Hearings have been held around the state. I attended ones on Long Island and in New York City, the latter lasted 5½ hours! The messages were passionate, poignant, scared, and angry. It was obvious that Medicaid consumers, advocates, and providers are concerned that the state’s health safety net will be decimated. I was especially impressed by those messages delivered by people with disabilities about their need to retain services in order to continue to live independently, and by behavioral health practitioners for the need to preserve mental health services while providing primary care. The need for coordination of care and less paperwork within the system was a frequent plea.
The Medicaid Redesign Team is providing advice to, not directing, the Cuomo administration. If we don’t help identify cost savings, across-the-board cuts will go into effect – this is a given. And, this is my nightmare. What will be the “unintended consequences” to the Medicaid program of even the most appropriate cuts? As a nurse, I never forget that these budget numbers represent people, their lives, families, and well-being.
NYSNA’s Board of Directors had heartfelt discussions about the state’s healthcare system, including the Medicaid program. As noted in our Medicaid Reform Talking Points, “the solution to the budgetary challenge is not dismembering the healthcare safety net, increasing the number of vulnerable residents without access to care, and alienating the next generation of the nursing workforce who can’t find employment as a result of shuttered facilities and hiring freezes.” There must be a coordination of primary, preventative, and long-term care services with incentives for meeting quality outcomes while controlling fraud, waste, and abuse.
As I write this column, the team is only now beginning the determination of specific cutbacks. NYSNA members and staff have been wonderful in providing insight into where the most obvious needs and pitfalls are, as well as the opportunities for change. I’ve heard from members in home care, long-term care, mental health, managed care, nursing administration, acute care, and outreach services. All have been articulate about the needs of their patients. To them, I say, “You are making a difference because you care for your patients, their health, your profession, and your state. I am proud of all of you!”
I know that nurses and this association can identify and support changes in Medicaid that will help this state meet its constitutional commitment to aid, care, and support the needy and that we will fight cuts and changes legislatively that would undermine the healthcare safety net and encroach on the Nurse Practice Act.