Fresh off frustrations with health spending in the budget and cuts to Medicaid ahead of future spending gaps, lawmakers introduced new legislation to require Managed Long Term Care plans to publicly report how they spend taxpayer dollars.
Lawmakers hope mandating plans to release detailed spending data will ensure that raises allocated for home care workers in past budgets will go to staffers as intended.
A bill introduced last week would require the state to make various Managed Long Term Care (MLTC) data public, including number of enrollees, the services people receive and how many home care hours a plan provides.
Sponsor Sen. Rachel May said it would show how much is spent on home care hours versus how many hours are kept for profit.
“We put an awful lot of effort to try to get the budget right, but if we don’t know where the money’s going, if we don’t know if it’s going to have the impact we want it to have, then what are we even doing here?” said May, a Democrat from Syracuse.
Several lawmakers said the state does little to monitor how MLTCs spend millions of dollars per year to provide home care and other types of adult care.
It’s become increasingly difficult for New Yorkers to find affordable care as the state’s population ages and the need for home care grows.
Minimum wage for home care workers is currently $17.55 north of Westchester County and will gradually increase through 2026 — done in the last budget to boost staff levels.
Greater access to home care aides prevents fewer people from needing to rely on nursing homes.
“It felt like a big shell game, so we’re trying to interrupt that shell game and get to a point where we know we’re making smart investments in the budget,” May said. “That’s a fight I’m ready to have any day.”
But Eric Linzer, president and CEO of the New York Health Plan Association, argues the legislation is unnecessary because plans already report extensive data to the state Health Department, which is made available to the public in a regular report.
He cited department data that shows 90% of enrollees rate their plan as “good” or “excellent.”
Linzer said the requirement would likely generate millions of dollars in new administrative costs and requirements at a time when providers are strapped in how they utilize Medicaid dollars.
“Those dollars should be focused on patients — not on new reporting, or on new reporting requirements that won’t result in better or more informed care for the state’s most vulnerable, low-income individuals,” he said Thursday.
Linzer hopes lawmakers tweak the proposal to ensure individual MLTC providers report data, adding they want to be part of the conversation with the Legislature to compromise on the legislation.
“There’s not a whole lot of information available on providers, particularly in the licensed home care service agency space,” Linzer said. “That’s where the focus really needs to be to understand [if] patients and members getting the services they need from their providers, because that information is already available about their plan.”
Lawmakers ultimately want to change state law to eliminate Managed Long Term Care plans altogether and transition back to a fee-for-service model, but its passage is unlikely with less than a month left of session. May said increasing transparency of provider spending is a solid first step before the Legislature undertakes a significant system overhaul in the coming years.
Valerie Bogart, counsel with the N.Y. Legal Assistance Group, noted the state pays each plan the same amount per member, but there’s a disparity in the type of care they receive depending on the plan.
Bogart argues mandating the data reporting will ensure the state Health Department holds plans accountable and keeps more New Yorkers out of nursing homes — especially after a state comptroller’s report showing thousands of people are not getting the home care they’re supposed to be.
“And the state promised the comptroller, ‘OK, we’re going to track that better,'” Bogart said. “Well, they haven’t. So this bill would say, ‘You have to do it. You have to have plans report. We can’t staff X number of cases for a week, for two weeks, for three weeks and let the plans be accountable for that. And they should be sanctioning plans that are not staffing cases.”
Bogart said plans have increasingly diverted high-needs patients into nursing homes and adult-care facilities in recent years, and consumers should be able to easily compare information about different plans.
“We live in a high-tech era. This is all possible to have all of this electronically,” she said.
The state budget included language to apply for a federal waiver to tax Managed Care Organizations, which is expected to generate a few extra billion dollars in revenue for a temporary period. State leaders have said the extra funds will be reinvested into Medicaid programs.
State Health Department leaders continue to analyze the waiver and options to implement the tax, according to the state Budget Division on Thursday. The Budget Division will additionally review the waiver before it’s sent in the coming months. Federal officials have told state leaders the waiver will be approved.
