Health, Department of

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Agency Web Site: https://www.health.ny.gov/

Mission

The mission of the Department of Health (DOH) is to ensure high quality health services are available to all New Yorkers. The Department is also the principal State agency that administers the Medicaid Program, the New York State of Health (NYSOH) Exchange, and other public health and health insurance programs.

The Department operates health care facilities including Helen Hayes Hospital, four veteran’s nursing homes, and the Wadsworth Centers for Laboratories and Research. In addition, DOH conducts oversight of health professionals and all other health care facilities to ensure that high quality, cost effective, health care alternatives are provided throughout the State.

Organization and Staffing

DOH is headed by a Commissioner, who is appointed by the Governor subject to Senate confirmation. The agency is organized into four major business units: the Office of Public Health; the Office of Primary Care and Health Systems Management; Institutional Management; and the Office of Health Insurance Programs which operates the Medicaid Program. Each of these business units contains multiple divisions and bureaus that work together to carry out DOH’s mission.

The workforce is spread out across the state, encompassing employees of the central office in Albany, four regional offices (located in Syracuse, New York City, Long Island, and Buffalo), the Wadsworth Center Public Health Laboratories, Helen Hayes Hospital (located in Haverstraw) as well as employees of the New York State Veterans’ Homes (located in Oxford, Queens, Batavia, and Montrose).

Budget Highlights

The FY 2022 Executive Budget recommends $188 billion for DOH, including $170 billion for Medicaid (represents two year appropriation authority), $5.5 billion for the Essential Plan, and $12.5 billion for remaining health program spending.

The Budget recommends a workforce of 5,418 full time equivalent employees (FTEs) for the Department. This is a decrease of 261 FTEs from the FY 2021 Budget. The decrease of 261 FTEs associated with a phased takeover of local district driven by a phase-in of employees to support the State’s takeover of local district administration of the Medicaid program (-222), with corresponding increases in the out year to restore to full target. These decreases are combined by a movement of 16 FTEs to the Office of Cannabis Management (OCM) for the medical cannabis program (-16), transition of HEMP/CBD monitoring to the proposed OCM (-17), and a removal of 6 special revenue FTEs that were offset in the prior year by a 10 FTE investment on the General Fund for family planning. (-6).

Major budget initiatives include:

• Telehealth. The COVID -19 pandemic has transformed the healthcare delivery system as methods for accessing care have expanded. Accordingly, the State is advancing a comprehensive package of telehealth reforms that will increase access to telehealth services. These include:

• Increasing access to services through comprehensive reform with changes to a variety of methods, including continuing telephonic delivery of care and establishing interstate licensure, allowing certain unlicensed staff (e.g. Credentialed Alcoholism and Substance Abuse Counselor trainees) to deliver substance use disorder services, expanding covered telehealth providers, eliminating obsolete location requirements, expanding reimbursement for patient monitoring, integrating telehealth into New York’s state-of-the-art health information network, the Statewide Health Information Network for New York (SHIN-NY), requiring telehealth in commercial insurance and expanding access to mental health and addiction services.
• Promoting innovative technologies and approaches by increasing training and education opportunities, establishing a pilot program to facilitate telehealth for vulnerable populations, requiring insurers to offer e-Triage and Virtual Emergency Department, and allowing insurers to satisfy contractual care management requirements by utilizing emerging telehealth solutions that enhance care management efforts and integrated multi-disciplinary teams.

• Medical Respite Pilot Program. The Budget establishes additional medical respite programs to provide care to homeless patients that are too sick to be on the street or in a traditional shelter, but not sick enough to warrant inpatient hospitalization. The pilots are designed to provide temporary room and board and the arrangement of health care and support services in order to improve the health of medically-impacted homeless individuals while also decreasing costly hospital use.

• Minimum Wage. In April 2016, the Governor signed into law the nation’s first statewide $15 minimum wage plan. The Budget includes nearly $2.0 billion to fully support the direct cost of the FY 2022 minimum wage increases for health care workers that provide Medicaid services reimbursed by the Department of Health. This includes funding to reconcile any identified underpayments in prior years. NYC wages met the $15 minimum wage standard as of December 31, 2019; however, growth continues towards the $15 minimum wage outside of NYC.

• State Takeover of Local Medicaid Costs. The Budget continues the Governor’s commitment to relieve local governments of Medicaid expenditure growth. In FY 2022, the State will assume nearly $4.8 billion in costs that would have otherwise been incurred by localities.

• Pharmaceutical Efficiencies. With enactment of the FY 2018 Budget, New York became the first state in the nation to pass sweeping legislation to control the skyrocketing cost of prescription drugs by setting the growth in Medicaid drug spending to an annual limit and providing the DOH with enhanced authority to negotiate additional rebates with manufacturers to maintain spending within the Global Cap.

• The FY 2022 Executive Budget will implement the transition of the pharmacy benefit from managed care to fee for service enacted in the FY 21 Enacted Budget and enhances the associated 340B investment. Additionally, the FY 2022 Executive Budget continues efforts to limit the rising cost of prescription drugs by extending the Medicaid drug cap through FY 2022. Further, the Budget enhances pharmacy oversight by eliminating “prescriber prevails” and coverage for certain over‐the‐counter products.

• Hospital Actions. The Executive Budget discontinues the State funded portion of the Public Indigent Care Pool (ICP) and reduces the hospital capital rate add-on by 5 percent. Public Hospitals still have the ability to fund the non-Federal share of ICP payments and can therefore still maximize Federal funding sources. Additionally, the Executive Budget continues the State’s commitment to supporting financially distressed health care facilities.

• COVID-19 Testing. The State will provide continued support for COVID diagnostic efforts, including fifteen 22 state operated testing location drive-thru sites and 7 walk-in sites located regionally throughout the state. Since the beginning of the COVID-19 pandemic, the State has successfully increased statewide capacity from 307 tests per day in the beginning of March to over 200,000 tests per day – among the most in the nation – by leveraging the State’s healthcare system and infrastructure, utilizing partnerships with facilities and laboratories, and identifying new technologies to increase volume and rapid testing options.

• COVID-19 Vaccination Program. Supporting the implementation of a statewide COVID-19 vaccination program that will be available to all New Yorkers within the year, ensuring a fair and equitable distribution to vulnerable and underserved communities within all regions of the state. The vaccine program will cover nearly 20 million residents at no cost, driving New York towards becoming the nation’s first COVID-safe state and accelerating the State’s re-opening effort.

• Statewide Healthcare Transformation. Continuing capital investments for health care providers to transition into fiscally sustainable systems and to support capital projects, debt retirement, working capital and other non-capital projects. The total amount of capital support provided to health care providers for transformation efforts to $3.8 billion.

• NourishNY. The Budget continues the Nourish NY Initiative supporting New York's regional food banks and local food providers’ ability to purchase surplus locally produced food and goods from New York farmers and dairy manufacturers and deliver it to New York families in need. To date, New York has provided $35 million for the Nourish NY program, in addition to annual funding of $36.9 million through the Hunger Prevention and Nutrition Assistance Program (HPNAP) administered by DOH. New investments of $25 million included in the Budget will bring the total funding commitment for the Nourish NY program to $60 million.

For more information on this agency's budget recommendations located in the Executive Budget Briefing Book, click on the following link:

Briefing Book – Health Care (PDF)

Program Highlights

Child Health Plus (CHP)

CHP provides comprehensive health coverage for children up to age 19 with family incomes above Medicaid eligibility levels. Like Medicaid, CHP is administered by states with guidance from the Centers for Medicare and Medicaid Services (CMS) and is jointly funded by the Federal government and states. Currently, more than 400,000 New York children receive health coverage through CHP. Families with incomes below 160 percent of the Federal Poverty Level (FPL) receive free coverage for their children while families with incomes over that threshold pay on a sliding scale from about $9-$60/month per child. Enrollees in CHP receive primary, preventive, specialty and inpatient care.

Federal funding for the Children's Health Insurance Program (CHIP) has been reauthorized through FFY 2027

Elderly Pharmaceutical Insurance Coverage (EPIC)

The EPIC program provides drug coverage to income-eligible seniors aged 65 and older to supplement out-of-pocket Medicare Part D costs. This program serves approximately 331,000 seniors annually and is financed entirely with State funds, which are offset by revenues from fees paid by EPIC members and rebates from drug manufacturers for generic drugs.

The Affordable Care Act (ACA) provides a phase-out of the Medicare Part D coverage gap (ended January 2020). The closure of the coverage gap will result in Medicare Part D picking up a larger share of program costs that were previously covered in EPIC.

Essential Plan (EP)

The EP provides health coverage for individuals with family incomes between 138 and 200 percent of the Federal Poverty Level (FPL) and for individuals from 0-200 percent FPL who are lawfully present in the United States but do not qualify for Medicaid due to their immigration status. The program has been extraordinarily successful, with nearly 800,000 New Yorkers enrolling at the end of FY 2020. The State receives Federal funding through the Essential Plan Trust Fund equal to 95 percent of what would have been provided to EP-eligible enrollees had they enrolled in the second lowest cost Silver Plan through the NYSOH. The EP offers a comprehensive package of benefits which include primary, preventive, specialty and inpatient care.

The Executive Budget makes significant investments through the Essential Plan through a three-point strategy as follows:

• Eliminating $20 monthly premiums for over 400,000 New Yorkers earning between $39,300 and $52,400 for a family of four, saving families nearly $100 million per year in premiums. This will promote coverage for upwards of 100,000 New Yorkers as the plan becomes more affordable.

• Increasing essential plan premiums by $420 million to support increased provider reimbursement for services provided to Essential Plan enrollees. This rate enhancement is expected to increase access to vital healthcare services.

• Establishing a $200 million Essential Plan Quality Pool to promote high quality of care. These funds strengthen provider networks, incentivize providers based on performance, and ensure provider access for all Essential Plan members.

Medicaid

Medicaid is a means-tested program that finances health care services for over 6 million low-income individuals and long-term care services for the elderly and disabled, primarily through payments to over 80,000 health care providers and more than 45 fully and partially capitated managed care plans. The Medicaid program is financed jointly by the State, the Federal government, and local governments. Eligible services include inpatient hospital care, outpatient hospital services, clinics, nursing homes, managed care, prescription drugs, home care and services provided in a variety of community-based settings (including mental health, substance abuse treatment, developmental disabilities services, school-based services and foster care services).

New York State of Health (NYSOH)

In 2013, in accordance with the Federal Affordable Care Act, the Governor issued Executive Order #42 to establish a New York Health Benefit Exchange. The Exchange – NY State of Health – serves as a centralized marketplace to shop for, compare, and enroll in a health plan. The health plans offered through NY State of Health are, on average, 55 percent less expensive than those available in 2013, prior to the creation of the marketplace. Since its inception in 2014, the NY State of Health has enrolled more than 5.7 million New Yorkers in affordable health coverage. The number of uninsured New Yorkers has declined by 1.3 million since 2010, setting an uninsured rate of 5.2 percent. The Executive Budget includes $442 million in total funding in FY 2022 for the operation of NYSOH.

Public Health

DOH promotes and protects the health of people and the communities where they live, learn, work, and play. These efforts work to prevent people from getting sick or injured and promote wellness. DOH staff are responsible for a wide range of public health issues including tracking disease outbreaks, educating the public about the health risks caused by alcohol and tobacco, and developing school nutrition programs. Major programs include:

• General Public Health Work (GPHW). The GPHW program, authorized under Article 6 of Public Health Law, provides reimbursement to counties and New York City for six mandated core public health services (Family Health, Communicable Disease Control, Chronic Disease Prevention, Community Health Assessment, Emergency Preparedness, and Environmental Health) by providing base grants and covering 36 percent of the remaining net costs, except for New York City, which the FY 2022 Budget reduces to 10 percent.

• Early Intervention (EI). The EI program provides a comprehensive array of therapeutic and support services to children under the age of three with confirmed disabilities (e.g., autism, cerebral palsy) or developmental delays. The program serves approximately 71,000 children annually and is jointly financed by Federal, State and local governments.

Note: Most recent estimates as of 01/19/2021