Health, Department of

Agency Web Site: http://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 2019 Executive Budget recommends $153.5 billion for DOH, including $142 billion for Medicaid (represents two year appropriation authority), including $4.3 billion for the Essential Plan, and $7.6 billion for remaining health program spending. This reflects an increase of $5.6 billion from the FY 2018 Budget due to the continuation of two-year appropriations for Medicaid, additional Federal Medicaid funding associated with projected programmatic growth, the Affordable Care Act, and minimum wage increases.

The Budget recommends a workforce of 5,463 full time equivalent employees (FTEs) for the Department. This is an increase of 381 FTEs from the FY 2018 Budget. The increase in FTEs is intended to provide staff to support the seventh year of the phased State takeover of local administration of the Medicaid program (+200), provide operational support for surveillance and certification activities within the Office of Primary Care and Health Systems Management and the Office of Public Health (+142), and to provide necessary resources to review Adult Home applications and provide background checks for Health Home Care Managers serving vulnerable populations (+39).

Major Budget initiatives include:

• Continuing Medicaid Redesign Team (MRT) reforms. A fiscally-neutral package of new MRT initiatives is proposed to make critical investments in health care delivery and support health care transformation. This package provides continued support to essential community providers, invests in the first 1,000 days of childhood development, enhances Medicaid reimbursement rates for ambulance providers, and grows the assisted living program (ALP) across the State. Investments are balanced by critical modifications to the Medicaid long term care program to ensure access to long term care services and supports for a growing aging population, along with continued controls on Medicaid pharmaceutical costs, and incentives to transition to value based payment arrangements, which fund needed investments in health care delivery and support further health care transformation.
• Supporting an additional $425 million capital investment for health care providers to transition into fiscally sustainable systems and to support capital projects, debt retirement, working capital and other non-capital needs. Of this amount, $60 million will be reserved for community based providers (i.e., clinics, home care, assisted living programs (ALPs), primary care providers), however, up to $20 million of the $60 million is reserved for expansion of ALPs beds, and $45 million will be reserved for residential health care facilities. This investment will bring the total amount of capital support provided to health care providers for transformation efforts to $3.7 billion over 5 years.
• Discontinuing Human Services Cost of Living Adjustment payments saving $19.9 million in FY 2019 and $45.4 million in FY 2020.
• Consolidating 30 public health programs into four pools, achieving $9.2 million in annual savings.
• Saving $3.2 million in FY 2019 and $11.9 million in FY 2020 in the Early Intervention program through a series of reforms that increase reimbursement from third-party insurers and streamline the evaluation process.
• Modernizing the American Indian Health pharmacy benefit by implementing a co-pay and formulary structure, mandating generic substitution, and accessing drug discounts and rebates, saving $1.5 million in FY 2019 and $5.9 million in FY 2020.
• Preserving funding for the Nurse-Family Partnership Program by shifting funding from the Office of Temporary and Disability Assistance to DOH.
• Continuing support for a life sciences laboratory public health initiative, which will develop life science research, innovation and infrastructure through a joint effort between Empire State Development and the DOH. Building upon the $150 million included in FY 2018, the FY 2019 Budget includes $600 million to support construction of a world-class, state-of-the art life sciences public health laboratory in the Capital District that will promote collaborative public/private research and development purposes.
• Providing $40 million to continue operational support for the State Health Information Network of New York (SHIN-NY) and continue to develop the All Payer Claims Database (APD).
• Protecting our children from exposure to lead paint by strengthening lead paint regulations requiring municipalities that administers the Uniform Fire Prevention and Building Code to report inspection and remediation outcome summaries to the Department of Health. Furthermore, State agencies would work together to ensure the inspection of residential and non-residential properties to ensure implementation of lead remediation measures to help reduce the risk of exposure to lead paint.
• Establishing the Maternal Mortality Review Board to review every maternal death in New York State and develop actionable recommendations to improve care and management.
• Introducing Comprehensive contraception coverage reform which requires individual and group commercial insurers to cover all FDA-approved contraceptive drugs, devices and products when prescribed by a health care provider, expands access to oral contraception, and allows for 12 months of oral contraception to be dispensed at one time.
• Extending the storage period for forensic rape kits at hospitals from 30 days to five years to prevent the untimely disposal of evidence, allowing victims more time to heal and make critical decisions.
• Advancing Stem Cell Research. Increase of $6.5 million in FY 2019 to support awards recommended by the Empire State Stem Cell Board. This $6.5 million is included within the total $600 million commitment to the program. To date, the life time disbursements for the Stem Cell program total $294 million of the commitment.
• Studing the implications of a regulated marihuana program. The Budget authorizes DOH to study, in consultation with other State agencies, the implications of a regulated marihuana program to determine the health, economic and criminal justice impact, and the consequences to New York State resulting from legalization in surrounding states.

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, approximately 350,000 New York children receive health coverage through CHP. Families with incomes below 160 percent of the Federal Poverty Level (FPL) can 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 CHP expired in September with no long-term solution in place. If Congress fails to reauthorize Federal funding, or reduces funding for the Child Health Plus program, the Budget proposes to allow the State to identify the amount of Federal funding that has been withheld, identify available resources or actions, and assess what programmatic changes are necessary to stay within current State funding levels.

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 312,000 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.

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 EP currently has enrollment of approximately 700,000 individuals statewide. The State receives Federal funding through the Essential Plan Trust Fund equal to 95 percent of what would have been provided to EP eligibles 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.

In FY 2018, the President took unilateral Executive action to withhold Cost Sharing Reduction (CSR) payments, threatening low-cost health insurance coverage for income eligible recipients when purchasing a Qualified Health Plan or Essential Plan coverage through the New York State of Health, New York's official health plan marketplace. Despite the Federal withholding of CSR payments, which amount to 25% of the Federal funding for the Essential Plan, the Executive Budget supports this program. In order to offset this loss of funding, the State will utilize EP Medical Loss Ratio (MLR) remittances, reduce reimbursement rates to plan rates to avoid future remittances, and accelerate trust fund to maximize Federal funding.

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 85 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)

NYSOH 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. To date, over 4.1 million New Yorkers have enrolled in coverage through the marketplace. In June 2017, the United States Centers for Disease Control and Prevention reported that the uninsured rate in New York dropped to 4.7 percent, the lowest ever reported in New York State. The Executive Budget includes $694 million in total funding for the operation of the NY State of Health.

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 NYC 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.
• 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 69,000 children annually and is jointly financed by Federal, State and local governments.

Note: Most recent estimates as of 01/16/2018