Public health systems in New York encompass the government-funded programs, facilities, and services that provide medical care, insurance coverage, and emergency response to residents. This page covers CBC’s work on Medicaid financing and reform, emergency medical services, health insurance coverage, mental health service delivery, and performance management for public health programs.
This page was created with AICBC Insights uses AI to group, analyze and present data and recommendations from CBC's publications. Always reference the cited sources to verify important details..
New York could implement a state individual mandate and penalty to protect against individuals relinquishing insurance in the future and causing instability in the individual market.
New York could provide additional state-funded premium assistance to reduce the cost of individual market plans for more people.
New York could procure and offer a state-sponsored public option plan through the State Marketplace with lower premiums and less cost-sharing than plans currently available.
New York could create a State-only funded Essential Plan to provide insurance for low-income immigrants who are currently ineligible for federally-funded coverage.
New York could provide additional funding for the State Navigator program to target areas where fewer people are insured than average.
New York could enable enrollment through tax returns to allow individuals to check their eligibility for health insurance programs.
New York could adopt policies to expand enrollment opportunities outside of open enrollment for those who miss deadlines or lose coverage.
Key Data
As of June 2025, New Yorkers report that satisfaction is especially low for mental health care, housing services, and homeless services.
As of May 2025, the City spends over $115 billion a year on services, and the next mayor is urged to focus on evidence-based programs in mental health and other areas.
Jackie most recently served as the Commissioner of the New York State Division of Homeland Security and Emergency Services from 2021 to 2026, where she oversaw emergency management, disaster recovery, counter terrorism policy, cyber security and emergency services for the state of New York. She served in New York City’s…
The proposed mayoral platform emphasizes the need for evidence-based programs to improve outcomes in critical service areas, including mental health. By prioritizing effective strategies over popular but ineffective ones, the city aims to ensure that significant annual expenditures deliver tangible results for residents.
Recommendations related to Public Health Systems
The next mayor should focus on what works by implementing evidence-based programs in mental health.
New Yorkers' satisfaction with city services, including health care availability and mental health services, has declined significantly since 2017. Only 54 percent of residents rate the availability of health care services as excellent or good, while mental health services receive a 22 percent positive rating.
Recommendations related to Public Health Systems
The Administration should incorporate this type of standardized, statistically valid feedback into its management systems and policy development to improve public health services.
The City should prioritize spending on high-impact programs that deliver positive results in public health and tackle the range of related policy challenges.
A continued focus on the basics, with emphasis on quality over quantity, is in order for public health service delivery.
The City should consider how to reduce spending and offer tax relief to middle-income households, who are feeling the City’s unaffordability acutely.
Efforts to fix service shortcomings, including those in mental health services, should be continued and possibly intensified.
Key Data
54%
— Citywide rating for the availability of health care services as excellent or good.
22%
— Citywide rating for mental health services as excellent or good.
65%
— Citywide rating for Emergency Medical Services as excellent or good.
New York's Medicaid program, the largest in the state budget, costs $101 billion this year and requires greater transparency to manage the rapid growth of long-term care services. Legislation requiring annual reporting on home care utilization and spending is a necessary first step toward the comprehensive health care system transformation needed to ensure sustainable financing and adequate workforce development.
Recommendations related to Public Health Systems
The Governor should sign A1926A/S1683A, a bill to require annual reporting on home care services.
The Department of Health should aggressively enhance its transparency efforts to provide the public access to cross-tabular, longitudinal spending, and utilization data disaggregated by geography, demographics, and other categories.
The State should pursue further reporting improvements to allow greater understanding of trends in health care services in order to inform health care system transformation.
Key Data
$101 billion
— The cost of the Medicaid program in New York State this year, which is the single largest program in the State’s budget.
New York City is set to receive over $22 billion in federal COVID-19 aid, yet current tracking systems fail to provide the transparency needed to manage these funds effectively. The City should implement a robust, public-facing tracker that details specific program goals, performance metrics, and spending outcomes to ensure accountability and maximize the impact of these resources on public health and other recovery efforts.
Recommendations related to Public Health Systems
The City should create a robust public tracker to support diligent management, ensure funds have maximum impact, and allow the public to know how money is being spent.
The Administration should implement a citywide performance management system where leaders and managers regularly review tracker data to identify what is working, address problems, and hold managers accountable.
The Mayor should establish a COVID Federal Aid Tracking Working Group, including representatives from the Office of Management and Budget, the Comptroller’s Office, and key City agencies, to develop the tracker's framework.
The tracker should be built and maintained by government, based on consultation with nonprofit and private organizations and fiscal oversight entities.
The tracker should include the appropriate funding streams, identify the programs being funded, and include performance goals and metrics for program inputs, outputs, outcomes, quality, and efficiency.
Key Data
$22 billion
— Total expected COVID-federal aid between fiscal year 2020 and fiscal year 2025.
$16.5 billion
— Total federal aid in the New York City budget for fiscal year 2022.
$5.9 billion
— Priority funding amount for the ARP State and Local Recovery Funds.
$7.0 billion
— Priority funding amount for Education Stabilization Funds.
$163 million
— Department of Education spending on supplies and materials.
$83 million
— Department of Education spending on pedagogical salaries.
New York State could significantly reduce its 1 million uninsured population by implementing strategies such as state-funded premium assistance, a public option plan, and expanded outreach programs. These initiatives, including a state-funded Essential Plan for low-income immigrants, would increase coverage rates and improve economic security for residents while requiring varying levels of state investment.
Recommendations related to Public Health Systems
New York could implement a state individual mandate and penalty to protect against individuals relinquishing insurance in the future and causing instability in the individual market.
New York could provide additional state-funded premium assistance to reduce the cost of individual market plans for more people.
New York could procure and offer a state-sponsored public option plan through the State Marketplace with lower premiums and less cost-sharing than plans currently available.
New York could create a State-only funded Essential Plan to provide insurance for low-income immigrants who are currently ineligible for federally-funded coverage.
New York could provide additional funding for the State Navigator program to target areas where fewer people are insured than average.
New York could enable enrollment through tax returns to allow individuals to check their eligibility for health insurance programs.
New York could adopt policies to expand enrollment opportunities outside of open enrollment for those who miss deadlines or lose coverage.
Key Data
1,000,000
— Number of New Yorkers who remained uninsured in 2019.
$803,000,000
— Estimated annual State cost for the deep premium subsidy program.
92,000
— Estimated number of newly insured individuals under the deep premium subsidy program.
$345,000,000
— Estimated annual net State cost for a State-funded Essential Plan for low-income immigrants.
46,000
— Estimated number of new enrollees for a State-funded Essential Plan for low-income immigrants.
65,000
— Estimated number of uninsured people who would obtain coverage through an expanded Navigator program.
New York should reconstitute its Medicaid Redesign Team into a Health System Transformation Team to improve healthcare access, affordability, and quality while ensuring fiscal sustainability. This transformation should focus on identifying efficiencies and savings, particularly as the program manages the addition of 1 million new enrollees brought in during the pandemic.
Recommendations related to Public Health Systems
The State’s Medicaid Redesign Team should be reconstituted as a Health System Transformation Team with a mandate to make recommendations to improve healthcare access, affordability, quality, and equity.
A Health System Transformation Team should identify specific initiatives that improve the effectiveness, efficiency, and equity of public health, primary and acute health care delivery, long term care, and behavioral health.
The State should take steps to improve the program’s fiscal stability and outlook by charging the Transformation Team to identify Medicaid efficiencies, program improvements, and savings.
Further improvements are still needed in transparency, by bolstering the State’s reporting requirements, to coordinate care for the highest-needs enrollees, and to fix the State’s global Medicaid spending cap.
Key Data
1 million
— New enrollees brought into the Medicaid program during the pandemic.
At the 2021 Annual Dinner, CBC presented its Medal for High Civic Service to Transportation Secretary Pete Buttigieg. CBC also presented its Felix G. Rohatyn Award to Alair Townsend. In addition, CBC presented the Prize for Public Service Excellence to The Vaccine Command Center, an interagency leadership effort led by…
At the 2021 Annual Dinner, CBC presented its Medal for High Civic Service to Transportation Secretary Pete Buttigieg. CBC also presented its Felix G. Rohatyn Award to Alair Townsend. In addition, CBC presented the Prize for Public Service Excellence to The Vaccine Command Center, an interagency leadership effort led by…
Federal aid from the American Rescue Plan should be prioritized for strategic interventions that address the health, mental health, and public safety challenges worsened by the pandemic. The city must reconsider its current budget allocations to ensure these funds effectively tackle chronic health disparities and support a sustainable economic recovery.
Recommendations related to Public Health Systems
Federal aid from the American Rescue Plan should be concentrated on strategic interventions designed in partnership with industry and nonprofit groups with a focus on addressing the health, mental health, homelessness, and public safety challenges that have been exacerbated by the pandemic.
The administration and City Council should reconsider federal funding allocations to ensure they address chronic health disparities that have substantially worsened during the pandemic.
New York City faces a significant fiscal cliff as temporary federal COVID-19 aid expires, leaving various initiatives, including critical mental health and public health programs, without long-term funding. The city allocated billions in federal support across these sectors, creating a substantial budgetary gap that must be addressed for fiscal year 2026 and beyond.
Key Data
$391.3 Million
— Total federal COVID-related aid allocated to Health and Mental Health Programs between fiscal years 2021 and 2025.
$300.0 Million
— Total funding allocated to the 'Mental Health for All' initiative within the Department of Education from fiscal years 2021 to 2025.
$160.2 Million
— Total funding dedicated to Mobile Mental Health Treatment programs from fiscal years 2021 to 2025.
$112.0 Million
— Total funding allocated for Mental Health Teams from fiscal years 2021 to 2025.
$70.0 Million
— Total funding provided for School Nurses through Flexible ARP Aid from fiscal years 2021 to 2025.
$50.0 Million
— Total funding allocated to the Public Health Corps from fiscal years 2021 to 2025.
New York State's pandemic response highlighted the necessity of a comprehensive performance management system to track public health benchmarks and ensure transparent, data-driven decision-making. Implementing such a system would allow the public to understand how resources are utilized and whether state actions effectively improve public health outcomes.
Recommendations related to Public Health Systems
The State should enact a ten-point framework by statute to promote consistency in reporting across agencies, authorities, and administrations.
The State should embrace a comprehensive performance management system to combine managerial action and accountability with key measures of program performance.
21,200 is the total number of inpatient hospital beds in New York State—approximately 2.5 beds for every 1,000 people. The pandemic has brought a significant attention to New York's health care system, and some have called for greater hospital capacity to help New York be better prepared for the future.…
2.9% was New York State's COVID-19 positivity rate as of November 10, 2020. New York was the early epicenter of the pandemic, and though new cases started to decline in April and stayed relatively low through the summer, cases are beginning to rise again. Joining the podcast is one of…
The COVID-19 pandemic significantly strained New York City's emergency medical services, evidenced by a 25 percent increase in the most severe medical incidents and a 10 percent rise in ambulance response times. These challenges highlight the necessity of reallocating resources toward medical response and implementing more robust performance metrics to better manage essential city services.
Recommendations related to Public Health Systems
The City should orient the structure of the Fire Department and its allocation of resources away from firefighting toward medical response.
The City should prioritize the importance of resident feedback surveys to collect high-quality data on key quality of life indicators.
The City needs robust performance metrics to foster an understanding of City services.
Key Data
25 percent
— The number of segment 1 medical incidents (the most severe) increased by 25 percent from 26,231 to 32,821.
10 percent
— Ambulance response times saw a 10 percent increase from 9 minutes and 22 seconds in fiscal year 2019 to 10 minutes and 19 seconds in fiscal year 2020.
14 percent
— Total fire company runs declined 14 percent as responses to medical incidents declined 11 percent.
New York State should implement a comprehensive, transparent performance management system to improve government accountability and service delivery, as demonstrated by successful applications in tobacco control and maternal care programs. Such a system would institutionalize goal setting, data gathering, and benchmarking to better inform resource allocation and improve outcomes across all state agencies.
Recommendations related to Public Health Systems
The State should develop performance metrics and benchmark against past results for maternal care programs to reduce infant mortality rates by focusing resources on the strategies that have proven to be most effective.
The State should utilize the successful model of tobacco control performance management, which includes regular goal setting and independent evaluations, to improve performance management in other public health grant-based portfolios.
The State should use performance metrics to evaluate maternal care programs on an ongoing basis, allowing for cross-sectional comparisons to better target resources on geographic and demographic bases.
Key Data
34 percent
— The reduction in infant mortality rates achieved by New York State maternal care programs over the past decade.
541
— The number of data files related to health available on the Open Data NY portal as of April 2020.
32%
— The share of total data files on the Open Data NY portal that are related to health as of April 2020.
70 million is the number of free meals distributed by the NYC since mid-March, when the COVID-19 pandemic took hold. Today we talk to members of the public and private sector teams that made this success happen: Sanitation Commissioner and "Food Czar" Kathryn Garcia, and Cas Holloway of Unqork, the…
CBC hosted a special panel discussion of prominent fiscal experts who helped New York overcome some of the most dire crises of the past. They provided insights and lessons from past experiences to help us understand and navigate the looming crisis. Stephen Berger Chairman, Odyssey Investment Partners; Former Executive Director,…
New York faces significant fiscal challenges in its Medicaid program, with multi-billion dollar gaps exacerbated by the COVID-19 pandemic and federal restrictions on cost-saving measures. To ensure program sustainability, the state must continue pursuing necessary reforms and transparency improvements while navigating these complex economic and health crises.
Recommendations related to Public Health Systems
The Executive and Legislature should include the Medicaid Redesign Team (MRT) recommendations in the budget, implementing those that do not risk federal funding immediately.
New York should lobby federal lawmakers to clarify and revise the COVID-19 response law to allow the state to implement planned cost savings.
The state should include transparency improvements to the Medicaid program, such as reporting and public data improvements, to help prevent future budget blunders.
The state should omit the provision for local share growth, as its inclusion would reverse an important achievement in state Medicaid finance policy.
The state should continue collaborative redesign and reform of the health care system, as health care delivery challenges persist outside of Medicaid.
Key Data
$4 billion
— The gap in the Medicaid program for fiscal year 2020.
$3 billion
— The gap in the Medicaid program for fiscal year 2021 and beyond.
$1.6 billion
— The amount in savings recommended by the Medicaid Redesign Team for fiscal year 2021.
$4.5 billion
— The annualized value of enhanced federal funding to the State.
$647 million
— The largest part of the savings package, which relates to long-term care.
$399 million
— The amount of savings identified in hospital payments.
The Medicaid Redesign Team's proposals fall short of the $2.5 billion savings target, leaving an $851 million deficit in the state financial plan. Furthermore, the recommendations fail to address necessary transparency improvements and structural issues within the Medicaid Global Cap, requiring further refinement to ensure fiscal goals are met without harming patient care.
Recommendations related to Public Health Systems
The State should implement needed improvements to transparency and the Global Cap’s accounting and design to prevent fiscal gimmicks.
The State should publicly provide critical data regularly, including spending information for all Medicaid agencies and unit costs of services.
The Executive and Legislature should re-define the structure of the Medicaid Global Cap through budget negotiations to address its current limitations.
The final negotiated budget must include fundamental fixes to the Medicaid program that ensure fiscal goals are met while minimizing negative impacts on the health care system and patients.
The Executive and Legislature should commit to making fiscal and statutory details available promptly to allow for proper review.
Key Data
$2.5 billion
— The savings target for Medicaid in fiscal year 2021.
$851 million
— The amount by which the Medicaid Redesign Team's proposals fall short of the savings target, leaving a deficit in the State financial plan.
$1.7 billion
— The amount of a payment delay resulting from fiscal maneuvers in March 2019 that went unreported for months.
$1 billion
— The amount of funding provided by the Indigent Care Pool to hospitals serving predominantly Medicaid and uninsured patients.
$1.6 billion
— The total amount of savings included in the Medicaid Redesign Team's proposals.
$890 million
— The amount of recurring savings taken in fiscal year 2020 used to close the fiscal year 2021 Medicaid budget shortfall.
New York's Health Care Reform Act (HCRA) taxes, which generate approximately $6 billion annually, significantly increase health insurance premiums for residents and are primarily used to offset state Medicaid costs rather than their original public health purposes. Lawmakers should avoid increasing these taxes, as they place a substantial financial burden on privately insured New Yorkers and depress wage growth.
Recommendations related to Public Health Systems
Lawmakers should review HCRA’s role in health care funding and its impact upon privately insured New Yorkers.
HCRA tax increases should be avoided as a strategy for balancing the Medicaid budget because that action increases the cost of health insurance premiums and likely depresses wage growth.
HCRA taxes should not be increased as part of the state's budget negotiations.
Key Data
$6 billion
— The approximate annual revenue generated by HCRA taxes.
4.3%
— The combined impact of the Hospital Surcharge and Covered Lives Assessment on health insurance premiums.
$1,000
— The statewide average annual cost of HCRA taxes for a family health insurance plan.
80%
— The portion of HCRA revenue used in recent years to pay for the State’s share of Medicaid.
$700 million
— The amount the State pays annually via HCRA taxes through the Surcharge on Medicaid and premiums for its own workforce.
$557 million
— The amount the federal government pays annually toward the Surcharge revenue.
New York's Medicaid program requires improved fiscal management and transparency, as current spending growth is unsustainable and obscured by accounting practices. To ensure long-term sustainability, the state should reform the Medicaid Global Cap, target resources to those most in need, and address rapidly rising costs in long-term care and personal assistance programs.
Recommendations related to Public Health Systems
The State should make the Medicaid Global Cap truly global by including all Medicaid spending rather than exempting specific costs.
The State should account for Medicaid spending using modified accrual principles to prevent the use of payment deferrals to adhere to the cap.
The State should index Medicaid spending to the rolling average of medical inflation to provide a sound metric for growth.
The State should improve Medicaid spending transparency by publishing monthly reports and detailed statistical data.
The State should focus on constraining costs in high-growth areas like long-term care, health homes, and the Consumer Directed Personal Assistance Program.
The State should target supplemental payments to hospitals based on financial need rather than current broad allocations.
The State should not raise health care taxes, as these costs are passed on to New Yorkers as higher health insurance premiums.
Key Data
$2.5 Billion
— The ambitious goal for State-share Medicaid savings identified by the Medicaid Redesign Team.
10%
— The approximate reduction in the Medicaid budget represented by the $2.5 billion savings goal.
$1.7 Billion
— The amount of Medicaid payments deferred by the State in fiscal year 2019 to adhere to the Global Cap.
$500 Million
— The cost of the health home care coordination model in its first five years.
50%
— The amount by which daily nursing home costs in New York exceed the national average.
$1,000
— The annual increase in health insurance premiums paid by the average commercially insured family in New York due to healthcare taxes.
New York City Health + Hospitals faces a persistent operating deficit, averaging $3 billion annually between 2015 and 2017, largely driven by outpatient services and insufficient Medicaid reimbursement rates. To address this, the system should implement multiyear financial planning with performance-based benchmarks and advocate for state-level reforms to Medicaid supplemental payments and more equitable distribution of commercial insurance surpluses.
Recommendations related to Public Health Systems
The City Office of Management and Budget and H+H leadership should develop a new approach to financial planning and budgeting with multiyear goals for increasing efficiency and revenue.
Progress toward performance benchmarks should be publicly monitored, and H+H leadership held accountable through compensation incentives tied to meeting these targets.
The State should better target Medicaid supplemental payments to facilities with the greatest need and finance the nonfederal portion with State revenues rather than local transfers.
State policy should use surplus operating revenue earned by large networks from commercial insurers to cross-subsidize indigent care on a system-wide basis.
The State should better align Medicaid hospital payment rates to reasonable unit costs of services.
Key Data
$3 billion
— Average annual operating deficit for H+H in fiscal years 2015 to 2017.
$1.7 billion
— Estimated City support to H+H in fiscal year 2019.
$2.3 billion
— Projected City support to H+H in fiscal year 2023.
53%
— Share of associated costs covered by Medicaid payments for H+H.
$16,590
— Case-mix adjusted cost per admission for H+H.
$12,033
— Case-mix adjusted cost per admission for safety net facilities.
The proposed New York Health Act, while aiming to improve insurance access and reduce financial barriers, is deemed unfeasible due to the necessity of federal waivers, massive tax increases, and potential legal challenges from self-insured firms. Instead, the state should pursue targeted reforms like individual insurance mandates, low-cost public plan options, and expanded subsidies to improve health coverage and affordability.
Recommendations related to Public Health Systems
The State should implement a mandate requiring individuals to have insurance to increase coverage and lower uncompensated care costs.
New York should create a new, low-cost public plan that specific populations can purchase at their own expense.
The State should increase the use of mechanisms that promote competition and transparency, such as reference pricing and value-based provider payments.
New York should consider expanding insurance subsidies to noneligible immigrants and those earning between 200 percent and 400 percent of the federal poverty level.
The State could pilot a geographic global budget by paying a coalition of providers a lump sum to care for the population in their area.
Key Data
$119 billion
— Projected annual funding required for the New York Health Act in 2022.
$179 billion
— Projected annual funding required for the New York Health Act in 2031.
156 percent
— Minimum tax increase required to fund the New York Health Act.
$139 billion
— Total cost of the New York Health Act in the first year.
$210 billion
— Total annual cost of the New York Health Act within 10 years.
$33.5 billion
— Annual tax revenue loss if 0.5 percent of top income bracket filers left New York.
New York State faces significant challenges in its health care system, including high costs, inadequate access, and inequitable outcomes, necessitating a strategic transformation. By pursuing targeted reforms such as an individual mandate, a public insurance option, and value-based payment models, the state can improve access and outcomes while restraining costs.
Recommendations related to Public Health Systems
Establish a state mandate that individuals must have insurance to ensure broader coverage and reduce public costs.
Create a new public insurance plan to provide a low-cost option for individuals and groups.
Extend and expand NYS Value Based Payment roadmap targets to accelerate the transition to value-based care models.
Require selected bundled payments for Medicaid and state employee coverage to improve care coordination and cost efficiency.
Support evidence-based interventions to coordinate care and integrate behavioral and physical health care to improve health outcomes for high-needs populations.
Key Data
90%
— US per capita health care cost is higher than the median of other high-income countries.
22%
— NYS per capita health care cost is higher than the national average.
5.7%
— The percentage of uninsured individuals in New York State as of 2017.
$411 million
— Estimated reduction in public costs to care for the uninsured if a state individual mandate is implemented.
156%
— Tax increase required to shift $139 billion from individual and firm premiums to tax revenue under a single-payer system.
76%
— Portion of the State budget that would be allocated for health coverage under a single-payer system.
The New York Mayor Bill de Blasio has come out with a plan that guarantees comprehensive healthcare for everyone, regardless of their ability to pay or immigration status. Blasio's surprise health scheme assures both primary and speciality care. Some Americans want to see the health initiative replicated nationwide. Watch the…
New York faces significant fiscal uncertainty regarding federal health funding, including potential changes to the Affordable Care Act that could impact billions in Essential Plan and Medicaid support. To address these risks and improve system efficiency, the state should adhere to the Medicaid Global Cap and pursue targeted measures to reform health care delivery rather than relying on unfeasible single-payer proposals.
Recommendations related to Public Health Systems
The State should prepare for possible changes to the Affordable Care Act by developing a plan to address the potential loss of federal funding for programs like the Essential Plan and Medicaid.
The State should continue to adhere to, and expand, the Medicaid Global Cap to ensure Medicaid cost growth remains controlled.
The State should pursue targeted measures to improve access, reform the delivery system, and support the safety net rather than adopting a state single-payer health care plan that is not currently feasible.
The State should consider including an individual mandate, a targeted public option health plan, or changes to the Disproportionate Share Hospital program to improve health care access and support the safety net.
Key Data
$5 billion
— Funding received by New York under the Affordable Care Act for the Essential Plan program.
$3.1 billion
— Funding received by New York under the Affordable Care Act for increased Medicaid eligibility.
$530 million
— Funding received by New York under the Affordable Care Act for tax credits to subsidize health insurance purchases.
$3.1 billion
— Funding received by New York under the Affordable Care Act for legally residing immigrant health insurance.
2,268 is the average daily number of people in adult psychiatric centers in New York State, a decrease from a peak of more than 93,000 people in 1955. Stephen Eide, a Senior Fellow at the Manhattan Institute, discusses the impacts of deinstitutionalization in New York.
New York City spends more than $1.1 billion annually on emergency medical services, yet the system is plagued by inefficiencies, including the frequent dispatch of expensive fire engines to non-emergency medical calls and a lack of focus on life-threatening incidents. To improve performance and reduce costs, the city should implement programs to divert non-emergency requests, optimize ambulance staffing models, and scale back the role of fire engines in medical responses.
Recommendations related to Public Health Systems
Build on the experience of other cities to develop programs to reduce residents’ unnecessary or inappropriate requests for an ambulance.
Increase the number of and more efficiently staff the ambulances which are best able to respond to the life threatening incidents (known as Advanced Life Support or ALS ambulances) so they can arrive at relevant incidents more promptly.
Dramatically reduce the role of fire engines in responding to medical incidents; they should be dispatched to these incidents only when it is likely the engine will arrive before an ambulance and the fire engine’s staff’s presence will result in quicker, appropriate medical treatment.
Enable one paramedic to staff ALS ambulances so that more are available to respond to the most time sensitive, life threatening incidents.
The City should conduct a thorough assessment of the location, coverage, and workload of fire companies to identify where companies could safely close without jeopardizing response times to any type of emergency.
Key Data
$1.1 billion
— Annual spending by the City of New York to provide emergency medical services.
$58.5 million
— Estimated annual savings from a 10 percent reduction in unnecessary or inappropriate ambulance requests.
$7.2 million
— Annual savings for every fire engine company closed.
1.5 million
— Total number of medical incidents the FDNY responded to in 2017.
38.7 percent
— Share of total incidents that were life threatening in 2017.
281,000
— Number of medical incidents to which fire engines responded in 2017.
New York's Medicaid program, while experiencing slower growth than other states due to reforms, remains one of the most expensive in the nation on a per-enrollee basis. Additionally, the state's uninsured rate has significantly decreased, falling from 12 percent in 2010 to 5.7 percent in 2017, largely driven by the implementation of the Affordable Care Act.
Key Data
$70 billion
— Medicaid spending in New York grew from $54 billion to $70 billion between fiscal year 2011 and fiscal year 2019.
5.7 percent
— The State’s uninsured rate decreased from 12 percent in 2010 to 5.7 percent in 2017.
$10,169
— In federal fiscal year 2016, New York’s per enrollee Medicaid costs were $10,169 compared to a national average of $7,714.
23 percent
— Medicaid spending in New York increased by approximately 23 percent between fiscal years 2011 and 2019.
1,441 is the number of overdose fatalities in New York City in 2017. NYC Commissioner of Health Dr. Mary Bassett discusses Healing NYC, a new program designed to combat the opioid health crisis, as well as neighborhood health clinics, lead testing at NYCHA and more.
176,000 is the number of New Yorkers statewide currently enrolled in Health Home, a Medicaid program that coordinates care for individuals with complex health needs. CBC Research Associate Patrick Orecki summarizes the state's experience with the Health Home initiative. You can read CBC's report "Options for Enhancing New York's Health…
New York's Health Home initiative, designed to coordinate care for Medicaid enrollees with complex needs, has faced challenges in meeting enrollment targets and demonstrating cost-effectiveness. To improve the program, the state should better target priority subpopulations, rely more on specialized entities, and strengthen the integration between managed care organizations and health homes.
Recommendations related to Public Health Systems
A reassessment of which subgroups should be assigned highest priority for enrollment, drawing on the evaluation and analysis recommended above, might better target the population to those with the greatest potential benefits and cost savings.
The creation of additional HHs with agencies such as these as the lead entity might improve enrollment efforts without recreating the limitations of highly specialized care management arrangements.
Pending such innovations efforts can be taken to facilitate and provide incentives for more productive interactions between MCOs and HHs.
A tiered rate structure with lower rates for those having been successfully served over some extended period of time might be more cost-effective.
The centralized mechanism could be direct initiatives by DOH or DOH support for activity by a coalition of stakeholder agencies who agree to share products.
Additional attention should be given by all stakeholders to ways in which better sharing of information can be facilitated.
Key Data
$558 Million
— Annual spending on Health Homes in 2017.
176,000
— Current enrollment in New York's Health Home initiative.
73 percent
— Percentage of Health Home enrollees who are also enrolled in Managed Care Organizations.
9,247
— Number of children enrolled in specialized Health Homes as of December 2017.
$110
— Monthly outreach rate effective October 1, 2017.
56 percent
— Percentage of all enrollees who have lower acuity.
The Governor's proposal to fund the Medicaid program using speculative proceeds from nonprofit-to-for-profit health insurer conversions is fiscally imprudent because these revenues are irregular and finite. Instead of using these windfall resources for recurring expenses, the state should prioritize using them to bolster reserves or fund one-time costs.
Recommendations related to Public Health Systems
The State budget and financial plan should not depend on $2 billion from this precarious source.
Furthermore, any proceeds earned by the State should not be used for multiyear budget balancing.
These revenues are episodic and finite and should be used to bolster reserves or fund one-time costs after proceeds are received by the State.
The use of these speculative, nonrecurring windfall revenues to pay for ongoing activities is imprudent.
Key Data
$3.75 billion
— The publicized price for the acquisition of nonprofit insurer Fidelis by for-profit Centene.
$4.6 billion
— The total amount generated for the State from the Empire conversion from fiscal year 2006 to fiscal year 2010.
$95 million
— The actual amount received by the State from conversion proceeds following the fiscal year 2009 enacted budget projection of $2.4 billion.
$500 million
— The amount of annual revenue the Governor's Financial Plan proposes to use to help pay for the Medicaid program.
$250 million
— The amount of annual revenue the Governor's Financial Plan proposes to put into a reserve to offset future federal cuts in health programs.
1.3 million
— The Medicaid enrollment of Fidelis, the largest Medicaid managed care insurer in New York.
NYC Health + Hospitals faces significant fiscal challenges, characterized by a growing dependence on city subsidies and a need for operational transformation to address structural deficits. While the new leadership aims to replicate successful turnaround strategies from Los Angeles, success in New York is complicated by a different market share, higher operational costs, and a less favorable intergovernmental policy environment.
Recommendations related to Public Health Systems
A strategy for improving H+H finances may require shifting selected services, notably uninsured outpatient visits, from the public to the private sector.
The source of fiscal stress from uninsured clinic visits can and should be shared more widely within the health care system.
Decreasing the concentration of psychiatric patients in H+H would potentially improve their care and enable H+H to improve its operations.
H+H likely will have to do more cost containment than was evident in Los Angeles.
Attention can be given to improving the outpatient payor mix.
Key Data
$607 million
— City subsidy to H+H in fiscal year 2011.
$1.8 billion
— City subsidy to H+H in fiscal year 2016.
$748 million
— Expenditure reductions sought by 2020 in the current plan.
$20,170
— Average cost per discharge (adjusted for case mix) at a H+H facility in 2015.
22.6 percent
— Amount by which the average cost per discharge at a H+H facility exceeded the average at New York City voluntary facilities.
35 percent
— Share of psychiatric discharges in New York City accounted for by H+H.
The first of a series of symposiums This event is the first of a series of symposiums on challenges in implementing Medicaid redesign strategies. Keynote address and presentation were given by NYS Medicaid Director Jason Helgerson.
New York's Medicaid redesign program, which aims to improve health outcomes through Performing Provider Systems, has struggled to effectively integrate community-based organizations due to unclear roles, financial challenges, and leadership skepticism. To address these issues, the state should prioritize replicating successful engagement models, fostering realistic financial expectations, and planning for the long-term sustainability of these provider networks beyond the current waiver period.
Recommendations related to Public Health Systems
Intensified State action to promote replication of effective arrangements with CBOs that have demonstrated some success in specific arenas and can feasibly be replicated.
Mutual acceptance among CBOs and lead organizations of modest expectations for financial arrangements related to arenas in which clear and effective roles for CBOs are not readily apparent and experimentation is needed.
Early and explicit attention to planning future arrangements for effective CBO engagement after the DSRIP waiver terminates.
The State and CMS should more explicitly address the options for the future of PPSs to provide stakeholders with a clear basis for planning their relationships.
Strategic attention should be given to identifying future funding streams for CBO participation in health care delivery.
Key Data
$8.0 billion
— Initial federal funds provided for the New York version of the DSRIP program over five years.
$184,235,967
— Total amount budgeted for CBOs by all PPSs across the five-year implementation period.
3.8%
— The share of total revenue allocated to CBOs across all PPSs.
$11.8 million
— Total amount disbursed by PPSs to Tier 1 CBOs during the first two years (April 2015 to March 2017).
6.3 million
— Number of residents covered by New York State's Medicaid program.
70 percent
— Percentage of the 224,000 identified Health Home-eligible people who had been enrolled as of September 2017.
Across New York City, 60.3% of residents rate the availability of health care services as excellent or good, while 69.8% provide the same rating for emergency medical services. These survey results highlight significant disparities in public health service satisfaction across Bronx community districts, ranging from 39.9% to 68.4% for health care availability.
Key Data
60.3%
— NYC residents who rated the availability of health care services as excellent or good.
69.8%
— NYC residents who rated emergency medical services as excellent or good.
39.9%
— Bronx Community District 1 residents who rated the availability of health care services as excellent or good.
68.4%
— Bronx Community District 8 residents who rated the availability of health care services as excellent or good.
44.7%
— Bronx Community District 1 residents who rated emergency medical services as excellent or good.
78.4%
— Bronx Community District 10 residents who rated emergency medical services as excellent or good.
A 2017 survey of New York City residents found that 60.3% rated the availability of health care services as excellent or good, while 69.8% gave positive ratings to emergency medical services. Despite these ratings, 10.1% of respondents identified health care as one of the most important issues requiring more attention from the city government.
Key Data
60.3%
— Overall proportion of residents who rated the availability of health care services as excellent or good.
69.8%
— Overall proportion of residents who rated emergency medical services as excellent or good.
10.1%
— Proportion of survey respondents who identified health care as one of the most important issues requiring more attention from city government.
New York's requirement for local governments to fund a significant portion of Medicaid creates an inequitable financial burden on taxpayers in less affluent counties and misaligns incentives for cost containment. The state should eliminate this local funding requirement and assume full financial responsibility for the program to ensure a more sustainable and equitable system.
Recommendations related to Public Health Systems
The state should take steps to fix a long-standing problem with how it pays for the program: its unusual requirement for substantial local government financing.
The State should assume responsibility for the local share liability over a period of four or five years.
New, statewide revenues will be required to replace the current local share in a way that relieves the disproportionate burden placed on taxpayers in low income counties.
Key Data
$7.1 billion
— Amount New York's counties will pay for Medicaid in state fiscal year 2012.
$6.5 billion
— Amount New York's counties paid for Medicaid in fiscal year 2008.
$555
— Per capita Medicaid burden in New York City.
$11.07
— Local Medicaid burden per $1,000 of personal income in New York City.
$4.6 billion
— Total local Medicaid payments in New York City in 2008.
$569,000
— Total local Medicaid payments in Hamilton County in 2008.
This presentation, from the CBC panel discussion "The Berger Commission: 10 Years On," reviews how health care services in New York City have evolved since the New York State Commission on Health Care Facilities in the 21st Century, known as "The Berger Commission" issued its recommendations in 2006.
Led by moderator Stephen Berger, the Chair of the Commission on Health Care Facilities in the 21st Century, panelists Elisabeth Benjamin of the Community Service Society and Jeffrey Kraut of Northwell Health and the NYS Public Health & Health Planning Council discussed challenges facing NYC's acute care sector. CBC Research…
New York State's Medicaid program represents a major public health initiative, with enrollment and costs serving as key metrics for the state's healthcare system. An infographic provides an overview of these figures to illustrate the scale and financial impact of the program.
New York City's hospital referral regions rank poorly in national health system performance metrics, particularly regarding prevention, treatment, and avoidable hospital use. While local hospitals perform well in specific areas like uninsured child rates, 85 percent of the city's hospitals received low quality-of-care ratings from the federal Centers for Medicare and Medicaid Services.
Recommendations related to Public Health Systems
New York City’s health care leaders, particularly those in the hospital sector, might benefit from examining other cities' efforts to improve the quality of care they provide.
Key Data
85 percent
— of New York City hospitals ranked below the modal three-star rating from the federal Centers for Medicare and Medicaid Services.
201 of 306
— is the overall ranking for the Bronx Hospital Referral Region, while Manhattan ranked 131 out of 306.
22
— hospitals in New York City earned only one star in the federal Centers for Medicare and Medicaid Services rating system.
New York's Medicaid program, which covers nearly one-third of the state's population, has successfully contained costs through initiatives like managed care and value-based payments, reducing the average cost per enrollee by 17% between 2010 and 2014. Despite these achievements, the state must aggressively pursue further reforms, including expanding managed care enrollment and improving coordinated service delivery models, to overcome ongoing implementation challenges.
Recommendations related to Public Health Systems
New York must make more progress toward the goal of enrolling nearly all Medicaid-eligible individuals in managed care plans.
The state requires greater use of coordinated service delivery models to improve care for those with multiple conditions.
Officials must address complex technical issues in identifying appropriate measures for the design and implementation of the value-based payment strategy.
Further gains in Medicaid reform should be pursued aggressively to improve the quality and cost of the program.
Key Data
34%
— The portion of the $156 billion State budget comprised by Medicaid.
6.3 million
— The number of New Yorkers provided access to medical care through Medicaid.
17%
— The decline in average cost per enrollee between 2010 and 2014.
$1.3 billion and $1.9 billion
— The annual savings target for state fiscal year 2020.
250,000
— The number of people intended to benefit from the Health Home initiative.
25
— The number of newly formed coalitions that coordinate care for targeted populations.
The New York City Fire Department's workload has shifted significantly from fire suppression to medical and other non-fire emergencies, with engine companies now handling a substantial portion of medical calls. In fiscal year 2015, fire department units completed over 1.1 million emergency responses, illustrating the evolving nature of the department's daily operations.
Key Data
1.1 million
— Total runs completed by engine and ladder companies in fiscal year 2015.
735,000
— Runs completed by engine companies in fiscal year 2015.
413,000
— Runs completed by ladder companies in fiscal year 2015.
34 percent
— Portion of all engine company responses that were medical emergencies.
74 percent
— Portion of all ladder company runs that were non-fire, non-medical incidents.
The FDNY faces a shift in demand where medical incidents account for 75 percent of the workload, yet funding remains heavily skewed toward fire operations at 56 percent compared to 28 percent for medical services. To address this imbalance and manage the loss of private ambulance providers, the department should transition to more efficient staffing models, such as pairing one paramedic with one EMT, and require EMT certification for firefighters to reduce reliance on ambulance backup.
Recommendations related to Public Health Systems
Modify Advanced Life Support (ALS) ambulance staffing to one paramedic and one emergency medical technician (EMT) for more efficient response.
Increase medical training for firefighters, allowing them to handle more emergencies without reliance on a subsequent ambulance and its staff.
Key Data
75 percent
— FDNY’s workload comprised of medical incidents.
5 percent
— FDNY’s workload comprised of fire incidents.
56 percent
— Portion of the agency’s budget spent on fire operations.
28 percent
— Portion of the agency’s budget spent on medical service.
$5 million
— Estimated annual savings from modifying ALS ambulance staffing.
81
— Number of daily ambulance tours the city must cover following the bankruptcy of a private provider.
The New York City Fire Department faces a significant mismatch between its traditional firefighting focus and the reality that the vast majority of its emergency responses are now medical in nature. To address this, the department should modernize its staffing and training models, including reconfiguring ambulance crews and training firefighters as emergency medical technicians, to better align resources with current service demands.
Recommendations related to Public Health Systems
The FDNY should apply again to the NYC-REMSCO to change ALS ambulance staffing to one paramedic and one EMT, which would yield about $5 million in savings and allow for the expansion of ambulance tours.
The FDNY should increase the medical training of firefighters so they can handle more situations without reliance on a separate ambulance and its staff, specifically by training firefighters as EMTs.
The FDNY should require EMT qualifications for new applicants for firefighter jobs, which would effectively create a career ladder for advancement among the EMS staff.
The FDNY should fundamentally reorganize the department to redefine the relationships between the two services and rebalance the financial and human resources provided for each type of service.
The FDNY should begin to lead the nation’s cities in the integration and redesign of firefighting and emergency medical service missions.
Key Data
75%
— Percentage of 2014 incidents to which FDNY vehicles responded that were medical incidents.
879,298
— Annual medical emergencies to which the FDNY responded.
$500 million
— Annual funding for EMS operations.
10.1
— Average runs per day for engine companies.
1,280
— Hours of training a paramedic receives including a field internship.
$5 million
— Potential savings from changing ALS ambulance staffing to one paramedic and one EMT.
New York City's health insurance costs have doubled since 2005, prompting a $3.4 billion savings agreement with the Municipal Labor Committee that currently relies on projected rather than actual savings. To ensure genuine fiscal relief, the city should implement structural changes like premium-sharing and improved chronic disease management rather than relying on national trends in health care inflation.
Recommendations related to Public Health Systems
Initiatives should “bend the cost curve” and achieve recurring savings for City taxpayers by establishing premium-sharing with employees and retirees, reducing per enrollee utilization of services, better managing chronic conditions, or lowering provider payments.
Savings should be counted clearly and honestly, meaning lower national and regional health care inflation, temporary premium rate “freezes,” and unusually low premium increases should not be credited as savings gained under the agreement.
The City should pursue initiatives such as reducing emergency room utilization and improving chronic disease management, which can improve health outcomes for the City’s workforce and save money for the City’s taxpayers.
Key Data
$2.6 billion
— Cost of the City's health insurance plan in fiscal year 2005.
$5.3 billion
— Cost of the City's health insurance plan in fiscal year 2015.
6.7 percent
— Portion of the 2015 budget comprised by health insurance costs.
$3.4 billion
— Total savings target agreed upon by the City and the Municipal Labor Committee between fiscal year 2015 and 2018.
$1.2 billion
— Savings credited to the Municipal Labor Committee agreement in the November modification.
9 percent
— Annual rate at which the financial plan projected health insurance spending to increase.
New York City's Health and Hospitals Corporation faces severe fiscal instability, with deficits projected to reach $1.7 billion by 2018 and cash reserves expected to be exhausted by 2016. To ensure long-term sustainability, the organization must modernize its operations, implement stricter expenditure controls, and establish a more stable financial relationship with the City.
Recommendations related to Public Health Systems
HHC will need to intensify its efforts to make service delivery more efficient and reduce unneeded hospital capacity.
MetroPlus also should seek to retain more of its members' utilization at HHC facilities, primarily by attracting patients to in-house providers because of their high quality relative to others and their proximity to member residences.
HHC should advocate for available state tax exemptions and funding sources conditioned on greater participation by voluntary hospitals in caring for the uninsured.
HHC and municipal leaders should develop more rational and stable guidelines for funding HHC.
Restructuring its services to stabilize its financial condition should be a top priority for state and local leaders.
Key Data
$668 million
— Deficit run by the Health and Hospitals Corporation in fiscal year 2013.
$645 million
— Estimated deficit for the Health and Hospitals Corporation in fiscal year 2014.
$1.7 billion
— Projected imbalance between revenues and expenditures for the Health and Hospitals Corporation in fiscal year 2018.
$2.2 billion
— Annual revenues of MetroPlus, a Medicaid managed care plan operated by the Health and Hospitals Corporation.
467,823
— MetroPlus enrollment figure in 2014, which more than doubled from 2005.
700,000
— Estimated number of New Yorkers who will still be left uninsured despite the Affordable Care Act.
The New York City Health and Hospitals Corporation faces significant financial instability, with projected budget gaps reaching $1.7 billion by fiscal year 2018 and a potential exhaustion of cash reserves by fiscal year 2017. To ensure long-term sustainability, the organization must implement effective cost controls, grow its MetroPlus managed care enrollment, and develop a more rational financial relationship with the City.
Recommendations related to Public Health Systems
Municipal leaders should develop more rational and stable guidelines for funding HHC in its efforts to meet its mandates.
City leaders should begin a dialogue with HHC and other national health care experts about the best way to rationalize the financial relationship.
HHC leaders can advocate for conditioning available tax exemptions and funding sources on greater participation by all voluntary hospitals in sharing the burden of caring for the uninsured.
In order to expand future enrollment HHC will need to take steps to improve the quality of the MetroPlus plan.
Service delivery needs to be made more efficient and unneeded hospital capacity reduced.
Key Data
$668 million
— The deficit run by the New York City Health and Hospitals Corporation in fiscal year 2013.
$1.7 billion
— The projected budget gap for the New York City Health and Hospitals Corporation in fiscal year 2018.
$3.2 billion
— The projected accumulated cash shortfall for the New York City Health and Hospitals Corporation by fiscal year 2018.
$4.8 billion
— The projected accumulated GAAP deficit for the New York City Health and Hospitals Corporation by fiscal year 2018.
48 percent
— The share of all certified psychiatric beds in New York City operated by HHC hospitals.
45 percent
— The share of citywide discharges of uninsured patients that comprised HHC’s hospitals.
The New York State Department of Health is profiled in a collaborative report with City & State. This profile is available on page 47 of the publication.
The New York City Health and Hospitals Corporation successfully reduced medical malpractice costs by 33 percent between 2003 and 2013 by assuming financial responsibility for claims and implementing safety initiatives like electronic medical records and infection prevention. This contrasts with the New York Police Department, where settlement costs grew by 60 percent during the same period, suggesting that holding agencies financially accountable for their legal liabilities can effectively drive cost-saving improvements.
Recommendations related to Public Health Systems
The City should include the cost of settlements and judgments in agency budgets so that these costs become a more explicit part of each City Commissioner’s responsibility.
Agencies should implement initiatives to improve safety and to eliminate errors including infection prevention measures, pharmacy robots, electronic medical records, and automated medication administration.
Agencies should create dedicated departments to assess which claims should be settled and which should be litigated in order to decrease payments.
Key Data
$674 million
— Total settlements and claims in the fiscal year 2015 budget.
54 percent
— Share of total settlements and judgments in fiscal year 2013 for which HHC and the NYPD were responsible.
33 percent
— Reduction in settlements and judgments against HHC between fiscal year 2003 and fiscal year 2013.
60 percent
— Increase in NYPD settlements and judgments between fiscal years 2003 and 2013.
$130.6 million
— Settlements and judgments against HHC in fiscal year 2013.
$137.2 million
— Total payouts of settlements and judgments by the NYPD in fiscal year 2013.
New York's health insurance marketplace, NY State of Health, successfully launched as a one-stop-shop for private and public coverage, enrolling nearly one million residents by April 2014. The system has facilitated access to affordable insurance, with premiums 53% lower than comparable 2013 coverage and significant support provided through a multilingual customer service network.
Key Data
960,762
— Number of residents enrolled in the NY State of Health marketplace as of April 16, 2014.
1,319,239
— Number of residents who completed the application process for health insurance.
1.2 million
— Number of calls answered by NY State of Health Customer Service Center representatives since the launch of the marketplace.
8,800
— Number of specially trained and certified assistors available to help people apply in person.
53%
— Percentage by which premiums for coverage purchased through the marketplace are lower than comparable coverage in 2013.
4,000
— Number of small businesses with 50 or fewer employees that have enrolled in the small business marketplace.
The New York City Health and Hospitals Corporation faces significant financial instability due to growing expenses and the potential loss of critical Medicaid supplemental payments. To address projected operating deficits exceeding $1.7 billion by 2016, the organization must improve service efficiency or face substantial reductions in care for needy residents.
Recommendations related to Public Health Systems
The New York City Health and Hospitals Corporation must redouble its efforts at delivering services more efficiently to avoid a dramatic reduction in the services it provides to needy residents.
The New York City Health and Hospitals Corporation and the City must identify new sources for funds to replace lost supplemental Medicaid payments.
The New York City Health and Hospitals Corporation must develop a more realistic gap-closing plan to address projected operating deficits that exceed $1.7 billion.
Key Data
$1.6 billion
— Annual revenues expected from Medicaid supplementary payments that may be in jeopardy.
$1.7 billion
— Projected operating deficit for the New York City Health and Hospitals Corporation in fiscal year 2016.
2,500
— Number of full-time employees trimmed by the New York City Health and Hospitals Corporation between 2009 and early 2012.
$218 million
— Reduction in personal service expenditures achieved by the New York City Health and Hospitals Corporation through headcount reductions.
$1.7 billion
— Total capital commitments made by the City for the New York City Health and Hospitals Corporation from fiscal years 2002 through 2011.
$850 million
— Value of unspecified gap-closing actions from the State and federal governments called for in the fiscal year 2016 plan.
New York's Medicaid nursing home payment system, which relies on outdated cost structures, results in high spending that does not correlate with superior quality of care. Reforming this system to lower payment rates and implementing financial incentives for quality improvements could generate necessary state savings while enhancing patient outcomes.
Recommendations related to Public Health Systems
The Medicaid Redesign Team should consider lowering payment rates even further to align with national norms.
The Medicaid Redesign Team should include a quality care pool to reward facilities for improving care to residents.
The Medicaid Redesign Team should strengthen the payment reform proposal to achieve greater savings and to provide financial incentives for improved care.
Key Data
$2.85 billion
— The annual Medicaid savings goal identified by the Medicaid Redesign Team.
$203.21
— The average per diem Medicaid rate for nursing home care in 2007.
30 percent
— The amount by which New York's 2007 average per diem Medicaid rates exceeded the national average.
$6.7 billion
— The total amount spent on residential nursing home care in New York in 2008.
$50,563
— The amount spent per Medicaid recipient in a nursing facility in 2008.
3.6 hours
— The average amount of direct nursing care provided per day in New York nursing homes in 2008.
New York's Medicaid program is the most expensive in the nation, with per-capita spending of $2,283 in 2007, more than double the national average. While recent initiatives like the Preferred Drug Program and the Office of the Medicaid Inspector General have generated significant savings, the state continues to face substantial cost growth, particularly in long-term care and community rehabilitation services.
Recommendations related to Public Health Systems
State officials should examine the substantial rates of increase in long-term care spending to isolate their causes and determine whether cost containment and program management actions are warranted.
The state should conduct further analysis on the growth in prescription drug spending, particularly given the implementation of the Medicare Part D program and the growth in the proportion of generic drugs used.
Policymakers should continue to consider the programs analyzed in this report for additional cost containment initiatives as part of ongoing efforts to more effectively manage the Medicaid program.
Key Data
$50 billion
— Total Medicaid spending in New York State, which is projected to grow to $53 billion in State Fiscal Year 2010-11.
$2,283
— NYS Medicaid spending per capita in Federal Fiscal Year 2007, which was the nation's highest and more than twice the national average.
$8,450
— NYS spending per enrollee in Federal Fiscal Year 2007, ranking as the second highest nationally.
$289 million
— Gross savings attributable to the Preferred Drug Program in State Fiscal Year 2008-09.
$1.02 billion
— Annual reported cost savings (State share) achieved by the Office of the Medicaid Inspector General in State Fiscal Year 2009-10.
$468 million
— Total cost savings (State share) reported by the Office of the Medicaid Inspector General for the first quarter of Calendar Year 2010.
New York's Medicaid program for nursing homes is the most expensive in the nation, yet it fails to deliver superior care or better staffing ratios compared to national averages. The state should transition to a standardized, performance-based payment system that links reimbursement to patient needs, regional labor costs, and measurable quality outcomes to improve care and reduce wasteful spending.
Recommendations related to Public Health Systems
New York homes should be staffed at the federally recommended level of 4.1 hours of care per patient per day; New York should be the national leader in nursing home quality—instead of just nursing home spending.
The nursing home industry should be held to the same accounting standards required of other industries that contract with government payers; an auditing system should be developed to detail whether the level of staffing assigned to a patient meets the criteria required according to the patient’s RUG category.
Financial incentives to provide measurable quality outcomes should be built into the system.
New York State should develop a set of quality indicators such as those being used in other states and being tested by Medicare to assess patient outcomes.
Homes should not receive their full daily rate if they fail to meet minimum quality standards; homes exceeding quality standards should be eligible for bonus payments.
Key Data
$45 billion
— Projected cost of New York's Medicaid program in fiscal year 2008-09.
$1.2 billion
— Annual cost of avoidable hospitalizations for nursing home patients in New York.
4.1 hours
— Federally recommended level of total nursing care per patient per day.
98 percent
— Percentage of New York nursing homes that do not meet federally recommended staffing levels.
$187
— Average daily Medicaid payment to nursing homes in New York.
$1.2 billion
— Total adjusted savings in fiscal year 2008-2009 from implementing a new payment system.
New York State's fragmented health insurance subsidy programs, including Medicaid, Child Health Plus, and Family Health Plus, suffer from inconsistent eligibility rules and administrative inefficiencies that prevent many eligible residents from receiving coverage. To improve access and reduce administrative costs, the state should implement an integrated eligibility system that separates health insurance enrollment from the public assistance bureaucracy and utilizes community-based organizations for outreach.
Recommendations related to Public Health Systems
The Governor should grant the Health Commissioner primary responsibility and authority to redesign the health insurance subsidy system and its supporting information systems.
The state should integrate eligibility determination for major health insurance programs into a new system created independent of the current public assistance eligibility bureaucracy.
The administration of the new system should rely on community-based organizations following the model of 'facilitated enrollment' for interviewing clients and reviewing documentation.
The state should begin a longer-term process of integrating eligibility determination for all major means-tested programs, including non-health programs.
The state should implement three high-impact measures: integrating Food Stamp eligibility, using school lunch administrators as facilitated enrollers, and coordinating Earned Income Tax Credit benefit determination with health insurance subsidy eligibility.
Key Data
5.1 million
— Number of New Yorkers estimated to be eligible for one of the state's health insurance subsidy programs.
$68 million
— Cost of 'Medicaid-only' eligibility offices in New York City in fiscal year 2000.
$464 million
— Annual Child Health Plus (CHP) appropriation in federal fiscal year 1999.
50 percent
— Rejection rate for public assistance applicants in New York City that remained above this level throughout the late 1990s.
one-quarter million
— Amount by which Medicaid enrollment shrank in New York City in the last half of the 1990s.
$117
— Administrative cost per recipient for 'Medicaid-only' eligibility offices in New York City in fiscal year 2000.
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