FINANCE

New York State health officials defended the Governor's proposed 2025-2026 budget during a joint legislative hearing Tuesday, emphasizing significant investments in healthcare workforce, maternal health, and nutrition programs despite concerns about federal funding uncertainty. Department of Health Commissioner James V. McDonald outlined a $113.6 billion DOH budget—45 percent of the entire state budget—representing an $8 billion increase from the prior year. Medicaid enrollment stands at 7 million New Yorkers, down from a pandemic peak of 8 million, while the Essential Plan covers 1.6 million, up 400,000 from eligibility expansions. The budget includes $1 billion in capital expenditures for the Safety Net Transformation Program and targeted investments from a Managed Care Organization Assessment: up to $305 million for hospitals, $200 million for nursing homes, and $50 million to increase physician fees from 80 percent to 90 percent of Medicare rates. The department is investing $694 million in healthcare workforce development under a federal 1115 waiver, plus $48 million in loan repayment. McDonald highlighted nutrition investments totaling $57 million for hunger prevention, $55 million for Nourish New York, and $26.3 million in state WIC funding. A universal free breakfast and lunch proposal would save students up to $1,600 annually and expand eligibility to 300,000 additional students. The budget also includes $20 million for reproductive health services and comprehensive maternal health initiatives across nine contracted hospitals. Sen. Samra Brouk raised urgent concerns about Rochester hospitals operating at over 120 percent capacity with the fewest hospital beds per capita in the state and a rapidly aging population. She questioned whether the proposed investments would sufficiently address the crisis. McDonald acknowledged a "complex discharge problem" in Rochester and said MCO Assessment funds could be deployed strategically to address regional disparities, including nursing home workforce shortages. Assemblywoman Amy Paulin pressed officials on implementation timelines for several initiatives, including the Certified Disability and Personal Care Assistant program, which must transition by April 1. McDonald said the program is ahead of schedule with over 90,000 calls to the call center and no wait times. Paulin also questioned the status of State Plan Amendments for hospital and Early Intervention funding, expressing concern about federal approval delays. Department of Financial Services Superintendent Adrienne Harris reported returning $645 million to New Yorkers during her tenure, including $228 million in 2024 alone. DFS has adopted 54 regulations, issued 98 guidance documents, and closed 117 enforcement actions resulting in $418 million in penalties since August 2021. Harris highlighted the department's sophisticated virtual currency team of 60 experts, which prevented FTX, Voyager, and Celsius from operating in New York and secured $2.1 billion in digital assets from Gemini Trust Company. Harris emphasized that 65 percent of the DOH budget depends on federal funding, primarily through Medicaid and federal grants. Both officials expressed concern about the federal transition and its potential impact on state programs, though McDonald said the budget assumes the federal government will honor existing commitments to New York. The hearing was the seventh of 14 joint fiscal committee hearings on the Governor's budget proposal. NEW YORK STATE SENATE FINANCE COMMITTEE HEARS HEALTH BUDGET TESTIMONY — Gender-Affirming Care, Medicaid Spending Growth, and Workforce Challenges Dominate Hearing The New York State Senate Finance Committee held a joint legislative hearing on February 11, 2025, to examine the 2025-2026 executive budget for health and related agencies. The hearing featured contentious exchanges over the state's response to federal restrictions on gender-affirming care, alongside testimony on Medicaid spending growth, nursing home funding, and persistent healthcare workforce shortages. Department of Health Commissioner Dr. Robert McDonald faced pointed questioning from Sen. Brad Hoylman-Sigal over the timing of hospital guidance on gender-affirming care following President Trump's January 28 executive order restricting federal funding for such procedures. Sen. Hoylman-Sigal cited statistics showing LGBTQ youth are four times more likely to attempt suicide than their peers, and noted a 72 percent increase in suicide attempts among transgender youth in states with anti-transgender legislation. He criticized the state's response as slow, noting that several hospitals had already preemptively paused gender-affirming care appointments. Commissioner McDonald characterized the federal executive order as "mean-spirited and wrong" and stated that DOH was sending a "Dear Administrator" letter to all hospitals, expected to go out "today or tomorrow," instructing them that healthcare workers have an obligation to provide continuity of care and cannot discriminate against patients. Medicaid Director Bassiri reported that overall medical spending is projected to reach approximately $124 billion in the upcoming fiscal year, up from $89 billion in 2022. She attributed much of the growth to expansion of the managed long-term care program, which now equals or exceeds the mainstream managed-care program covering 5 million-plus New Yorkers. Sen. Gallivan pressed for details on how the state is managing this spending growth and verifying eligibility. On capital funding, Commissioner McDonald announced $250 million available for the Statewide IV program (to be announced in the next couple of weeks) and $450 million for Statewide V (to be announced later in the year), with $1 billion-plus allocated for Safety Net Hospital Transformation. He noted that DOH received $4 billion in total capital funding requests. Sen. Gallivan emphasized the importance of geographic distribution to rural communities, and Commissioner McDonald acknowledged the need to balance urban and rural healthcare needs. Nursing home reimbursement remained contentious. Assemblyman Jensen questioned why the budget does not restore approximately 15 percent in capital reimbursement cuts enacted previously. Commissioner McDonald noted that recent increases included a 7.5 percent increase two years ago, a 1 percent increase last year, and a $285 million per-diem increase, but acknowledged that nursing homes struggle with workforce costs and capital project funding. Assemblywoman Forrest challenged Commissioner McDonald's support for the nursing compact as a solution to Rochester's healthcare staffing problems. She cited data showing that new RN licenses increased 49 percent from April 2018 to January 2025 (224,416 new licenses), while RN employment in New York remained relatively flat at 4 percent growth. She argued the real problem is working conditions, not licensure, and noted that half of ICU units are in violation of minimum nurse-to-patient ratio requirements. Commissioner McDonald acknowledged that half of nurses with licenses are not involved in direct patient care, identifying this as the critical issue. Sen. Helming, ranking member on Insurance, expressed skepticism about the effectiveness of prior workforce investments, noting that despite $650 million invested in training initiatives in the Greater Rochester area last year, healthcare workforce shortages persist. She pressed Commissioner McDonald for specific budget allocations addressing rural suicide prevention and Greater Rochester healthcare challenges. On substance use disorder, Sen. Fernandez, chair of the Substance Use Disorder committee, praised DOH's drug-checking services and buprenorphine expansion efforts. Commissioner McDonald noted that DOH has conducted "literally thousands" of drug checkings through the Office of Drug User Health, helping people discover that their illicit drugs contain unexpected substances like xylazine or fentanyl. DFS Superintendent Harris testified on the livery insurance market crisis, noting that three insurers control about 90 percent of the market and have been insolvent for decades due to underpricing. He stated that DFS just published its first examination reports of these companies since 1987. Harris also noted that DFS currently has just under 1,400 employees but faces increasing mandates, including regulation of cryptocurrency and climate oversight. He warned that federal regulatory cutbacks—including the shutdown of the Consumer Financial Protection Bureau and the FDIC's rescission of 200 examiner offers—will shift additional work to DFS. On the CDPAP transition, Assemblyman Weprin noted that over 280,000 people rely on the program, but as of January 31st, only 22,000 consumers had completed or started enrollment with PPL. He raised concerns about language translation services, which Director Bassiri disputed, stating that PPL has translation in all languages. The hearing underscored ongoing tensions between state and federal health policy, persistent healthcare workforce challenges, and questions about the adequacy of proposed funding solutions for nursing homes and rural healthcare systems. NEW YORK STATE SENATE FINANCE COMMITTEE — A joint legislative hearing on the 2025-2026 health budget revealed significant concerns about implementation timelines and funding disparities, with senators expressing skepticism about the state's ability to execute major program transitions by April 1st. The most contentious exchange centered on the Medicaid Consumer Directed Personal Assistance Program (CDPAP) transition to a single fiscal intermediary, Popular Fiscal Intermediary (PPL). Sen. Gustavo Rivera, chair of the Health Committee, publicly stated that the April 1st deadline "does not work," noting that with approximately 280,000 consumers remaining to enroll and only 49 days until the deadline, PPL would need to process roughly 5,000 enrollments daily. Medicaid Director Bassiri reported that as of January 31st, only 40,000 consumers had started or completed enrollment, with 22,000 fully transitioned. When pressed on contingency plans, Bassiri acknowledged "the potential that we don't meet the steep" targets but offered no detailed Plan B, instead suggesting health plans would ensure continuity of care. Sen. Rivera warned that without a viable backup plan, vulnerable consumers could lose access to essential services. Sen. John Liu criticized the Department of Financial Services for allowing an insurer insolvent since 1979 to continue operating in the for-hire vehicle market while shuttering the only commuter van insurance company, imperiling immigrant communities. He urged Superintendent Harris to develop solutions rather than "abdicate responsibility." Sen. Griffo pressed DOH Commissioner McDonald on funding disparities between Downstate Medical Center ($450 million capital, $100 million operating) and Upstate University Hospital ($200 million capital), demanding parity. When McDonald responded that she lacked "a checkbook," Griffo replied: "I think the money would be more important. Your love is appreciated." Sen. Gonzalez raised alarms about emergency department capacity in Lower Manhattan, where most hospitals operate at over 90 percent capacity. She questioned whether the system could handle another public health crisis, particularly if Mount Sinai Beth Israel closes as proposed. On maternal mortality, Commissioner McDonald outlined $13 million in annual funding for 30 community-based organizations and a $3 million Nurse Family Partnership investment, but acknowledged that data on program effectiveness would take time to mature. The Medical Indemnity Fund also drew scrutiny. After requiring a $58 million emergency infusion last year to prevent insolvency, the Executive Budget proposes only the baseline $52 million, prompting Assemblyman Slater to ask why no substantial reforms were proposed. McDonald indicated willingness to collaborate on solutions but deferred specific proposals. The hearing underscored tensions between the administration's implementation timeline and legislative concerns about readiness, particularly regarding vulnerable populations dependent on state health programs. NEW YORK STATE HEALTH BUDGET HEARING HIGHLIGHTS DISPUTES OVER MEDICAID TRANSITIONS, ELIGIBILITY VERIFICATION Albany — A joint legislative hearing on the 2025-2026 executive health budget revealed sharp disagreements between the Hochul administration and lawmakers over proposed Medicaid program transitions, eligibility verification discrepancies, and funding for safety-net hospitals. DOH Commissioner James McDonald defended the administration's plan to transition the Consumer Directed Personal Assistance Program (CDPAP) and school-based health centers from fee-for-service to managed care, arguing New York spends disproportionately on home care. He cited a 2020 CMS report showing New York spent 43 percent of the nation's total home care spending, with fiscal intermediaries paid $150 to over $1,000 monthly—far above national averages. But Sen. Gustavo Rivera expressed strong skepticism, noting that health plans and sponsoring organizations oppose the transition and some are already closing school-based health centers. "If the organizations that are sponsoring them are saying that they're not willing to put up with this change, that they can't manage it, so they're closing the school-based health centers, that is the impact that we're looking at," Rivera said. "And that's already happening." Sen. John Borrello challenged the administration on Medicaid eligibility, citing a discrepancy between 7.3 million enrollees reported on the state website and only 6.4 million verified as eligible in a FOIL response to the Empire Center. "If it's $10,000 a year cost to the taxpayers in New York State, that's $10 billion potentially that we are spending on people that are not eligible to be on Medicaid," Borrello said. Medicaid Director Amir Bassiri insisted there is no discrepancy and all verified enrollees are eligible. On applied behavioral analysis services, the administration proposed cutting reimbursement rates for unlicensed practitioners from $77 to $38.50 per hour, aligning with other states. Assemblyman Andrew Hevesi questioned whether children with autism in foster care or the juvenile justice system would lose access, but Commissioner McDonald and Director Bassiri insisted service levels would be maintained. Sen. John Rhoads raised alarm about Nassau University Medical Center, which he said has lost $500 million in state funding over six to seven years and received zero dollars in Distressed Hospital Funding despite serving as a Level I trauma center and safety-net hospital for 1.4 million residents. The budget includes changes to the Temporary Operator Statute that could enable a state takeover. Chairwoman Liz Krueger highlighted concerns about healthcare access for undocumented immigrants amid federal immigration enforcement threats, and advocated for increased DOH staffing to handle professional misconduct investigations, which she said can take four to six years. The hearing, held Feb. 11, also addressed nursing home Medicaid rate rebasing (unchanged since 2007), lead service line replacement delays, and insurance market stability. (Word count: 398) NEW YORK STATE SENATE FINANCE COMMITTEE EXAMINES 2025-2026 HEALTH BUDGET AMID CONCERNS OVER CDPAP TRANSITION, INSURANCE CRISIS, AND NURSING HOME VIABILITY Albany — State health officials faced pointed questioning from lawmakers on February 11 during a joint legislative hearing on the 2025-2026 Executive Budget on Health, with particular scrutiny focused on a controversial transition of the Consumer Directed Personal Assistance Program (CDPAP) to a single vendor scheduled for April 1st. DOH Commissioner Michael McDonald and Medicaid Director Kristin Bassiri defended the CDPAP transition, asserting that the vendor, PPL, is ahead of schedule on its ramp-up plan and has established 150 physical locations statewide. However, lawmakers expressed alarm at the pace of transition: only 22,000 of approximately 280,000 CDPAP consumers have fully transitioned to PPL as of the hearing, leaving 258,000 consumers with less than 50 days until the mandatory April 1st deadline. Assemblyman Eichenstein pressed Commissioner McDonald on how the state would transition the remaining consumers in time, noting that nonprofit fiscal intermediaries are being displaced by the for-profit vendor. DFS Superintendent Adrienne Harris faced separate criticism over insurance market challenges. Assemblyman Blumencranz highlighted that DFS received 35,722 fraud complaints last year but investigated only 77 cases, resulting in just 24 arrests. He noted that New Yorkers faced upwards of 20 percent homeowner's insurance increases and that the state saw the fourth-highest insurance premium increases in the nation. Harris acknowledged the department has six open investigator positions and stated DFS would pursue competitive procurement for Narcan next year, though she defended the current sole-source contract as providing the lowest price in the nation. Sen. Bailey, the newly appointed chair of the Insurance Committee, raised concerns about insurance discrimination against certain building types and affordable housing developments, framing the issue as both an insurance and housing crisis. He also pressed Harris on whether California-style insurer exodus could occur in New York, and advocated for school-based health centers and mental health services in schools. Rural healthcare emerged as another major concern. Sen. Stec, representing upstate New York, warned that nursing homes are in financial peril despite a proposed $400 million investment in the budget. He cited the closure of the last assisted living center in St. Lawrence County and expressed skepticism that current reimbursement rates adequately address the divergence between rising costs and flat Medicaid payments. Commissioner McDonald acknowledged the nursing home community has sought solutions for five years and committed to exploring certified medication aide positions and nursing workforce strategies. Sen. O'Mara pressed for clarity on the status of the Rural Ambulance Task Force report and expressed frustration over the lack of progress on Interstate Compact nursing licensure, noting that 43 states have already joined the compact. Commissioner McDonald stated he saw the task force report but does not hold it, and expressed support for the Interstate Compact, saying he knows of no rational argument against New York's participation. Other issues addressed included Early Intervention program implementation challenges, dental access disparities, and concerns about foster care insurance availability. The hearing underscored significant implementation challenges and funding pressures across New York's health system as the state prepares for major program transitions. New York State health officials faced pointed questioning from legislators on February 11 during a joint budget hearing, with particular scrutiny focused on the controversial transition of the home care program to a single fiscal intermediary and concerns about drinking water safety standards. Sen. Julia Salazar pressed DOH Commissioner McDonald on delays in designating PFAS chemicals as emerging contaminants, more than a year after the state's Drinking Water Quality Council recommended the action. The commissioner attributed the delay to waiting for EPA guidance but committed to codifying federal PFAS standards if they are rolled back under the current administration. The CDPAP home care program transition dominated much of the hearing. Medicaid Director Bassiri reported approximately 40,000 enrollments so far, with half still in early stages, toward a target of 240,000 people plus 700,000 caregivers. The single fiscal intermediary, Public Partnership Limited (PPL), is required to maintain a $100 million line of credit. However, Assemblywoman Kelles expressed alarm about potential gaps in the April 1 transition date, warning that stricter eligibility requirements could force more people into nursing homes—which cost the state significantly more. Assemblywoman Lucas raised concerns about PPL being sued in Pennsylvania for wage theft and questioned whether DOH adequately vetted the contractor. Assemblyman Maher challenged whether a 4 percent Medicaid rate increase for nursing homes—roughly $100 million in new investment—is sufficient to address a $1.6 billion Medicaid gap. Commissioner McDonald acknowledged the pressure on Medicaid, which is already $8 billion over last year's spending. Certified home health agency access emerged as another crisis area. Assemblywoman Reyes cited declines of 33 percent in the Bronx, 40 percent in Rochester and the Finger Lakes, and 35 percent in the Capital District since 2019, creating bottlenecks in hospital discharges. Medicaid Director Bassiri said the department is focusing on workforce training and certification rather than asking managed-care plans to offset Medicare reductions. EMS reimbursement rates also drew criticism. Assemblyman Maher questioned whether rates of $249 per basic life support transport and $429 for advanced life support are adequate, given rising operational costs. Commissioner McDonald said the issue requires continued examination but noted budget constraints. DFS Superintendent Harris defended the Bank Development District program, noting seven branches opened during her tenure, though Assemblyman Anderson criticized the slow pace and lengthy application process. She also addressed cybersecurity enforcement, noting DFS's 2023 regulation update has become a model for federal regulators and over half of states. The hearing revealed significant implementation challenges ahead for the April 1 CDPAP transition and broader concerns about whether state health spending adequately supports providers and ensures access to care. NEW YORK STATE SENATE FINANCE COMMITTEE HEARS HEALTH BUDGET TESTIMONY AMID FEDERAL FUNDING THREATS Albany — State health officials and healthcare industry representatives testified before the Senate Finance Committee on Tuesday regarding the 2025-2026 Executive Budget on Health, with witnesses expressing deep concern about potential federal Medicaid cuts while largely supporting the Governor's proposed investments in healthcare. The hearing revealed significant tensions over healthcare reimbursement rates and program transitions. Chairman Pretlow pressed Medicaid Director Bassiri on why community health center reimbursement rates remain based on 1999 costs, calling the situation untenable given that these centers provide primary care to many New Yorkers. Bassiri acknowledged the problem but said rebasing rates is not possible under current law, offering only alternative payment methodologies as a solution. Senators also expressed serious concerns about the April 1 deadline for transitioning the Consumer-Directed Personal Assistance Program (CDPAP) from independent providers to licensed agencies. Sen. Rivera noted that between 200,000 and 300,000 workers serve 280,000 consumers in the program, and said testimony today had not adequately addressed stakeholder fears about the transition. "The fears have not been assuaged," he stated. On Early Intervention services, Commissioner McDonald confirmed a 5 percent rate increase plus a 4 percent rural modifier, but acknowledged delays in federal approval. The State Plan Amendment was not submitted until December 31, 2024, though payments will be retroactive to October 1 once approved. Healthcare industry representatives largely supported the Governor's budget, particularly the use of managed care organization tax revenue for healthcare investments. However, they diverged sharply on the proposed Fair Pricing Act. The 32BJ Health Fund, representing 200,000 union members, cited a Brown University study showing the price cap could save $1.1 billion annually, with $213 million in direct patient savings. But the Healthcare Association of New York State warned the proposal would destabilize hospitals already operating on unsustainable margins. The most urgent concern across testimony was federal action. Ken Raske of the Greater New York Hospital Association noted that his organization filed suit yesterday against the National Institutes of Health for taking $850 million from New York research institutions—part of a $9 billion national cut. "My fight is in Washington," Raske said, urging bipartisan legislative support to protect Medicaid from proposed federal cuts targeting $2 trillion over 10 years. Chairwoman Krueger focused on network adequacy, noting constituent complaints that insurance company directories list doctors who don't accept new patients or don't know they're in the network. She emphasized the need for clear regulations to ensure the promised network adequacy review is properly funded and implemented. The hearing underscored New York's healthcare system facing simultaneous pressures: aging demographics (860,000 more seniors by 2030), workforce shortages, hospital financial instability, and the looming threat of federal Medicaid reductions. NEW YORK STATE LEGISLATURE HEARS COMPETING VISIONS ON HEALTHCARE BUDGET PRIORITIES Albany — Healthcare industry representatives and patient advocates clashed Tuesday over how New York should allocate $1.4 billion in managed care organization tax revenue and address critical gaps in primary care and workforce, during a joint legislative hearing on the 2025-2026 Executive Budget. The hearing, held before the Senate Finance Committee and Assembly Ways and Means Committee, revealed sharp disagreements over the state's proposed CDPAP transition to a single facilitator model, hospital financial sustainability, and primary care investment. Ken Raske of the Greater New York Hospital Association cited alarming statistics to support his argument that Medicaid underpayments are strangling the healthcare system. He noted that CDPAP has grown 500 percent in recent years compared to 46 percent overall Medicaid growth, and that one in four insurance claims submitted by hospitals are denied by insurers — a rate he called "baloney." "The root cause of the lack of investment is the underpayments," Raske told lawmakers, urging them to use regulatory authority to cut the denial rate in half. Bea Grause of the Hospital Association painted a dire financial picture, reporting that 50 percent of hospitals have negative operating margins and 25 percent are unsustainable at 3 percent or less. She opposed the Governor's proposal to require hospitals to maintain sexual assault forensic examiners on call at all times, calling it an unfunded mandate with an unrealistic October 1st implementation deadline. On primary care, Louise Cohen of the Primary Care Development Corporation testified that approximately 95 percent of healthcare dollars bypass primary care, leaving only 5-7 cents on the healthcare dollar for prevention and early treatment. She advocated for the Primary Care Investment Act, which would require payors to gradually increase primary care spending to 12.5 percent of total healthcare spending — a model already adopted by California, Massachusetts, Oregon, and other states. Meanwhile, patient advocates pushed back against the Governor's proposed use of MCO tax revenue. Mia Wagner of the Health Care For All New York Campaign, representing 170+ organizations, urged lawmakers to use some of the $1.4 billion to make children's health insurance more affordable for middle-income families and to increase funding for Navigator and Community Health Advocates programs. The CDPAP transition emerged as a contentious issue. While Helen Schaub expressed support for moving to a single facilitator model to eliminate intermediaries engaged in "wage theft" and excessive executive compensation, Eric Linzer of the Health Plan Association warned that PPL, the designated single facilitator, has demanded "hundreds of millions of dollars" in funding advances and excessive reimbursement rates — contrary to the state's expectation that consolidation would create savings. "Plans should not be expected to be PPL's bank," Linzer said, warning that members could face service disruptions if PPL is not ready by the April 1st deadline. Sen. Gustavo Rivera signaled openness to postponing the CDPAP transition if problems emerge, while Sen. Liz Krueger emphasized the need for federal-level solutions to healthcare funding while pushing the state to expand primary care investment. The hearing underscored the Legislature's challenge in balancing competing interests — hospital financial stability, patient affordability, workforce development, and primary care expansion — amid uncertainty about federal healthcare funding cuts. NEW YORK STATE SENATE FINANCE COMMITTEE HEARS CONCERNS OVER MEDICAID SPENDING GROWTH, LONG-TERM CARE CRISIS, AND PRIMARY CARE UNDERFUNDING The New York State Legislature's Joint Health Budget Committee heard testimony on February 11 that painted a stark picture of healthcare system challenges despite record Medicaid spending increases. The hearing on the 2025-2026 executive budget revealed deep concerns about unsustainable cost growth, nursing home bed closures, and inadequate primary care funding. Bill Hammond of the Empire Center for Public Policy warned that the state's Medicaid spending is growing at an unsustainable rate. The proposed budget calls for a $6.4 billion (17 percent) increase in state Medicaid spending, continuing a four-year trend in which the state share has grown 60 percent—more than three times the previous decade's average. Comprehensive Medicaid spending, including federal and local contributions, has ballooned from $89 billion to $124 billion in four years. Despite this spending, Hammond noted, New York still has low-performing hospitals and nursing home problems, and faces potential federal Medicaid cuts. Sebrina Barrett, newly appointed CEO of LeadingAge New York, delivered urgent testimony about the long-term care crisis. The Governor's budget provides only a 1.3 percent funding increase for long-term care and does not restore a 15 percent cap cut. Barrett documented significant service losses: 3,500 nursing home beds have closed since 2014, 7,200 more are offline due to staffing shortages, and potentially 72,000 additional beds could close if current trends continue—totaling nearly 83,000 beds. She cited specific closures, including United Helpers' assisted living program in St. Lawrence County and reductions in the Oswego-Syracuse region. Reimbursement rates, she noted, have not been updated since 2007. On primary care, multiple witnesses called for increased investment. Rose Duhan of the Community Health Care Association of New York State noted that community health center rates have not been updated since 2000 and requested 15 percent of MCO tax revenues be dedicated to primary care, including $75 million for rate increases. Her organization represents 80 community health centers with 900 sites serving 2.4 million New Yorkers. Chairwoman Lara Krueger highlighted research showing that new patient visits cost $88.39 in primary care settings but $436 in hospital-based facilities, underscoring the cost implications of site-neutral payment policies. Eric Linzer of the Health Plan Association disputed claims about high claims denial rates, presenting data showing that in 2023, 75 percent of 312 million claims were paid in full, 15 percent were denied in full, and 10 percent were paid in part. He attributed many denials to non-covered benefits (23 percent), coding issues (13 percent), and duplicate claims (7-8 percent). However, Linzer expressed concerns about the April 1st CDPAP transition timeline and the adequacy of guidance for implementing mental health reimbursement mandates. Meg Ryan, CEO of Nassau Health Care Corporation, reported operational improvements at the public hospital system, including expanded services and a 600 percent increase in cash reserves from 2023 to 2024, despite serving a patient population that is 80 percent Medicaid, Medicare, or uninsured. However, she opposed the Executive Budget proposal to give the Department of Health increased power to install temporary operators without hearings and requested restoration of aid and funding for CSEA contract negotiations. Senators pressed witnesses on implementation timelines, funding sustainability, and the adequacy of proposed investments. The hearing underscored tensions between the Legislature's desire to invest in primary care and long-term services while controlling overall Medicaid spending growth. NEW YORK STATE SENATE FINANCE COMMITTEE — A joint legislative hearing on the 2025-2026 Executive Budget on Health revealed sharp divisions over Medicaid spending and highlighted a dramatic financial turnaround at Nassau University Medical Center, while nursing home operators warned of widespread closures without immediate funding relief. Ms. Meg Ryan, president of Nassau University Medical Center, reported that the hospital moved from $11 million in cash reserves at the start of 2024 to $90 million by year-end, while reducing its projected deficit from $180 million to $80 million. The turnaround occurred without state funding for five years, she said, and despite the hospital serving as Nassau County's only safety-net facility and sole burn center. Ryan also disclosed that NUMC has been fronting the state share of Disproportionate Share Hospital (DSH) payments for decades, totaling over $1 billion, with $50 million fronted last year alone. Sen. John Rhoads praised the hospital's performance, calling the improvements "quite impressive" and criticizing the Department of Health's focus on "leadership" as a condition for funding. "Stop playing politics with the leadership of this hospital," Rhoads said, urging the Governor and Commissioner McDonald to provide necessary funding. Meanwhile, LeadingAge New York warned that nonprofit nursing homes face a $1.6 billion funding gap and estimated that approximately 83,000 beds could come offline if current trends continue. Ms. Kathy Barrett, LeadingAge's president, cited a 15 percent capital funding cut and noted that nursing home rates have not been rebased since 2007. She said the closures are driven primarily by funding shortages that prevent facilities from recruiting and retaining staff, with some members reporting plans to reduce from 900 beds to 100 beds by year-end. Sen. Chris Ryan pressed Barrett on the single biggest contributor to bed closures, and she identified funding as the primary driver. "No room at the inn is not an answer," Sen. Ryan concluded. On Medicaid policy, Mr. Hammond argued for reducing enrollment, which he said has reached 40-44 percent of the state population, well above the poverty rate of 15-16 percent. He recommended implementing two 2020 measures that have not yet been enacted: restructuring disability eligibility determinations and conducting more serious asset look-backs for financial eligibility. Sen. Rivera challenged Hammond's cost-cutting approach, arguing that New York's more robust Medicaid program is a positive and that the state should invest more in safety-net institutions. "I would argue that there's certainly a lot of work that does point out some of these things that we could actually be better at," Rivera said. "I just have an issue with the notion that we should just spend less and we'll be fine." Ms. Linda Duhan of the Community Health Care Association of New York State supported broader coverage, arguing that ensuring as many people as possible have health insurance reduces long-term costs by creating a healthier population. Other testimony focused on research funding and emergency physician compensation. Jonathan Teyan of the Associated Medical Schools of New York reported that New York is the second-leading recipient of NIH funding at $3.6 billion annually, supporting 17,000 jobs in research. He expressed concern about potential federal funding cuts and requested the Legislature fully fund state research initiatives. Katelynn Ethier of the New York American College of Emergency Physicians supported Article VII Part F and the proposed MCO tax, but requested that a significant portion of the $50 million Medicaid physician fee schedule increase be earmarked for emergency services. She noted that New York ranks 49th out of 50 states in Medicaid reimbursement for emergency medicine. The hearing, held Feb. 11 before the Joint Legislative Committee on Finance, underscored tensions between cost control and service expansion as lawmakers prepare the state budget. New York State legislators heard testimony on the 2025-2026 health budget at a joint Finance Committee hearing on February 11, with witnesses raising alarm about critical shortages in children's services and physician retention while supporting military family initiatives. The Department of Defense urged lawmakers to enact the Nurse Licensure Compact, arguing it would help military spouses maintain nursing careers while following servicemembers to duty stations nationwide. Christopher Arnold, a DOD liaison, testified that military spouses lose an average of $39,000 in wages per move due to licensing delays, with families relocating every two to three years. He noted that all five neighboring states have successfully implemented the compact while maintaining healthcare standards, and that the military considers licensure reciprocity when making strategic basing decisions. Dr. Paul Pipia, representing the Medical Society of the State of New York, strongly opposed several budget proposals, particularly a $40 million cost imposition on 16,000 physicians with excess malpractice insurance. He warned the proposal would drive more physicians out of New York, which already trains 15 percent of the nation's physicians but loses them to other states. He also opposed eliminating physician supervision requirements for physician assistants, arguing PAs are trained as assistants, not independent practitioners. Children's health services drew the most urgent testimony. Dr. Michael Grossfeld of Agencies for Children's Therapy Services reported the Early Intervention system is "past its breaking point," with 10,000 children on waiting lists—a 500 percent increase since 2020. A 2023 state Comptroller report found 51 percent of EI children did not receive full eligible services and 3,000 received none at all. Grossfeld attributed the crisis to inadequate reimbursement rates that have declined 15 percent over 29 years while inflation rose 70-160 percent. He also cited software failures in the newly launched EI Hub system that have prevented referrals from being entered. New York ranks 50th of 50 states in timely EI service delivery. Maureen O'Grady, a licensed behavior analyst, opposed proposed cuts to Medicaid-funded ABA therapy, warning they would result in the nation's lowest ABA reimbursement rate and cause providers to exit the program, as happened when rates were initially low. She noted families have waited nearly a decade for this coverage. On a positive note, the New York Water Safety Coalition praised the Governor's water safety investments, including $5 million for swimming lesson vouchers for children under 4, $50 million for pool construction and renovation, and $3.5 million for transportation assistance. Jim Spiers cited drowning as the leading cause of death for children ages 1-4, with severe racial disparities: Black children 5-9 drown at 2.6 times the rate of white children. Senators expressed particular concern about prior authorization delays in insurance coverage. Assemblymember Weprin cited a 2006 study showing physicians spend two hours on administrative tasks for every hour of patient care, and advocated for his bill requiring timely insurance determinations. The hearing underscored tensions between budget constraints and service delivery crises in healthcare, with lawmakers facing pressure to address physician retention, children's therapy shortages, and insurance company practices. NEW YORK STATE SENATE FINANCE COMMITTEE HEARS TESTIMONY ON HEALTH BUDGET FAILURES Legislators heard damning testimony on Wednesday about systemic failures in Early Intervention services, nursing home funding, and home healthcare access during a joint hearing on the 2025-2026 Executive Budget on Health. The most urgent crisis centers on Early Intervention, where providers reported payment delays and reductions following the October 15, 2024 launch of the new EI Hub system. Dr. Michael Grossfeld testified that providers received only a 5 percent reimbursement increase instead of the promised 11 percent, and that payment delays have forced some agencies to miss payroll. Assemblywoman Giglio noted that providers are abandoning telehealth services—which serve rural and hard-to-reach areas—due to proposed 22 percent cuts downstate and 10 percent cuts upstate. Assemblyman Jensen called the situation "Groundhog Day," saying the state must fundamentally restructure Early Intervention delivery rather than continue "nickel-and-diming" the system. Nursing home representatives requested a full 20 percent Medicaid rate increase, arguing the state's average rate covers only 75 percent of care costs. Kristin DeVries of the New York State Health Facilities Association said this would require an additional $460 million state investment. Lindsay Heckler of the Center for Elder Law & Justice made an emotional case for raising the personal needs allowance for nursing home residents from $50—set in the 1980s—to $200 monthly, citing Assembly Bill A2048. Sen. Gustavo Rivera, the Health Committee chair, expressed interest in working with her office to quantify the cost. The most technically complex testimony involved Certified Home Health Agency (CHHA) services. Dan Lowenstein of VNS Health explained that Medicaid managed care plans pay one-third to one-half what the state's episodic payment system provides, causing providers to reject cases. He cited a 256 percent increase in CHHA referrals over five years but barely any increase in actual admissions, leaving patients stranded in hospitals. Patients not receiving CHHA services are 43 percent more likely to die and cost $2,100 more per patient overall, he testified. Lowenstein requested $70 million in targeted resources for "home health deserts" and asked the state to make the episodic payment system visible to managed care plans so they can negotiate appropriately. Chairwoman Liz Krueger pressed Lowenstein on whether the problem was a coding glitch or system design flaw, noting that past discussions identified patients trapped in hospitals due to CHHA shortages. "It's a glitch, honestly," Lowenstein replied. Assisted living providers also testified to a crisis, with Chris Vitale of the Empire State Association of Assisted Living requesting restoration of the EQUAL and Enriched Housing programs, permanent increases to the Assisted Living Program rate (stuck at 1992 levels), and expansion of the Special Needs Assisted Living Residence voucher program from $7.75 million to $15 million. The hearing revealed a pattern: underfunding and system failures across multiple long-term care sectors, with legislators expressing frustration that incremental budget increases have failed to address structural problems. NEW YORK STATE LEGISLATURE HEARS DIRE WARNINGS ON CDPAP TRANSITION IMPLEMENTATION Legislators heard scathing testimony on Tuesday about the state's troubled transition of the Consumer Directed Personal Assistance Program to a single fiscal intermediary, with advocates warning that an April 1 deadline is mathematically impossible to meet and could leave 80,000 vulnerable New Yorkers without essential home care services. The joint Senate Finance and Assembly Health Committee hearing on the 2025-2026 Executive Budget on Health revealed a cascade of implementation failures in the PPL transition, which was mandated in last year's budget. Bryan O'Malley of Consumer Directed Action of New York calculated that PPL must enroll 10 consumers and workers every minute until March 29 to meet the deadline—a pace the organization says current trends show is unachievable. "Based on the department's reported trends to this point, giving them the benefit of the doubt and counting started and confirmed consumers, they will fall about 80,000 people short," O'Malley testified. He noted that only 22,000 consumers have actually completed enrollment, despite DOH's claims of progress. Testifiers from the New York Association on Independent Living, Caring Majority Rising, the Home Care Association of New York State, and PHI detailed systemic problems: inadequate translation services, generic English-only notifications that violate cybersecurity best practices, wrong enrollment packets sent to consumers, and wage information withheld or posted at rates lower than promised. "It's been a train wreck," said Ilana Berger of Caring Majority Rising, describing conversations with consumers and workers experiencing the transition. "This is a $9 billion contract impacting millions of people. We've got to do better. We've got to delay the timeline." Sen. José Rivera expressed frustration with the Department of Health's insistence on the April 1 deadline, calling it "mathematically" impossible and repeatedly urging the administration to reconsider. "Please change the tape for the second floor," he said, addressing DOH leadership. Testimony also revealed a troubling secondary effect: 27,000 people have already moved from CDPAP to more expensive LHCSA-based agency care at a cost of $1.55 more per hour, with 7,000 additional people transitioning weekly. Advocates warned that if the CDPAP transition fails, tens of thousands more could end up in nursing homes or hospitals—far more costly to the state. The hearing also addressed broader home care workforce crises. PHI testified that New York has 650,000 direct care workers but faces over 1 million projected job openings between 2022-2032. Direct care workers earn $3.23 per hour less than other occupations with similar entry requirements, and 36 percent live in or near poverty. Assemblywoman Alessandra Biaggi (Kelles) expressed alarm at the lack of basic information: "We don't know how many people were in the previous program. We don't know how many providers there were. We don't know what the payment plan is. We have six weeks. I'm sort of flabbergasted." Legislators called for delaying the transition timeline, increasing funding for home care agencies and independent living centers, and investing in direct care worker wages. The hearing underscored growing concern that the state's approach to CDPAP reform could inadvertently increase Medicaid costs while harming vulnerable populations. NEW YORK STATE SENATE FINANCE COMMITTEE HEARS TESTIMONY ON HEALTH BUDGET, FOOD INSECURITY, AND VITAL RECORDS ACCESS Albany — The New York State Senate Finance Committee held a joint legislative hearing on February 11, 2025, examining the 2025-2026 executive health budget, with testimony revealing significant concerns about food insecurity across the state and a controversial proposal to restrict access to vital records. Food security advocates presented a unified call for increased state funding, citing alarming statistics. The U.S. Department of Agriculture's Economic Research Service reported that one in eight New York households now experience food insecurity, up from one in 10 the previous year. Emergency food program visits have surged 70 percent since 2019, while food prices have climbed 25 percent in the same period. Multiple organizations requested $75 million each for the Hunger Prevention and Nutrition Assistance Program (HPNAP) and Nourish NY, compared to the executive budget proposals of $57.8 million and $55 million respectively. The West Side Campaign Against Hunger reported demand for food is now three times pre-pandemic levels and 50 percent higher than peak pandemic demand. The Food Pantries for the Capital District coalition served over 104,000 individuals in 2024, a 50 percent increase from 2023. Reverend Dustin Longmire of the Schenectady County Food Council emphasized the need for a $100 minimum SNAP benefit, noting the current $23 monthly benefit is inadequate. He warned of community members panicking over potential federal SNAP cuts. Chairwoman Liz Krueger expressed skepticism about direct state contracting with thousands of individual food pantries, suggesting organizations work with food banks to resolve operational disputes instead. A second major controversy emerged over Part U of the proposed health legislation regarding vital records. Genealogical organizations strongly opposed the measure, arguing it does not digitize records as claimed but instead imposes some of the nation's most restrictive embargo periods: 125 years for births, 100 for marriages, and 75 for deaths. The proposal would also increase fees by over 300 percent. Alec Ferretti of the Association of Professional Genealogists noted that genealogy requests represent only 4 percent of vital records requests but face a five-year backlog. He emphasized that the Department of Health has already spent over $2 million on digitization contracts and scanned more than 30 million certificates as of December 2022. Joshua Taylor, president of the New York Genealogical and Biographical Society, highlighted an unintended consequence: the proposal would effectively prevent adoptees' descendants from obtaining original birth certificates, contradicting a 2019 state law championed by Assemblyman David Weprin. Taylor noted that neighboring states like Connecticut, Massachusetts, New Jersey, and Vermont make vital records essentially public. Sen. Rivera questioned whether proper staffing of the Department of Health would be a better solution than restricting public access, noting the department received only seven additional staff lines despite a 10,000-request backlog. Chairwoman Krueger expressed concern about the proposal's timing, noting that as the federal government restricts research and historical access, New York should not follow suit. NEW YORK — Advocates for hospice care, HIV services, overdose prevention, and end-of-life options testified before the state Legislature on Tuesday evening that the 2025-2026 executive budget fails to adequately address critical health crises, with hospice providers receiving zero state funding despite New York ranking last nationally in access to palliative care. Jeanne Chirico, president of the Hospice and Palliative Care Association of New York State, told the Finance Committee that hospice has received no state support for workforce development in recent years, despite a critical shortage of workers preventing patients from dying at home. She requested $20 million for hospice workforce initiatives and $3 million to fund an Advanced Care Planning Campaign authorized in 2022 but never funded. "We are at such a critical moment in the hospice industry," Chirico said, noting that approximately 4 million Medicare-eligible New Yorkers rely on hospice services. Charles King of Housing Works criticized the Governor's proposed legislation on enhanced rental assistance for people living with HIV outside New York City, saying it has been passed six consecutive years without housing a single person. He requested $10 million for overdose prevention centers, $15 million additional for hepatitis C elimination, and legalization of drug paraphernalia for harm reduction. King noted that hepatitis C treatment is now an 8-to-12-week course with a 95 percent cure rate, but funding for outreach and testing remains inadequate. Michael Davoli of the American Cancer Society Cancer Action Network focused on paid family and medical leave, citing a young mother with three children who was laid off while pregnant because she needed time off for cancer treatment. He urged the Legislature to include language from Senator Ramos' and Assemblywoman Solages' bill in the final budget, saying cancer patients should not have to choose between treatment and feeding their families. Corinne Carey of Compassion & Choices advocated for the Medical Aid in Dying Act, noting it is supported by 72 percent of New York voters and has been adopted in 11 U.S. jurisdictions. She emphasized the bill includes more than a dozen safeguards modeled after Oregon's 1994 law, and that less than 1 percent of people in states with such laws use them. She also requested $20 million from the proposed MCO tax for hospice and palliative care workforce development. Sen. Fernandez asked detailed questions about overdose prevention, noting high rates in Black and brown communities and rural counties along the Southern Tier. Sen. Rivera expressed support for overdose prevention centers, paid family leave, and medical aid in dying, asking about national context and federal enforcement risks. Food assistance advocates testified about inefficiencies in the current system, with some larger food pantries able to save money through independent purchasing but restricted when receiving Nourish NY funds through food banks that limit them to single vendors.