FINANCE

NEW YORK STATE SENATE FINANCE COMMITTEE — Acting Health Commissioner James McDonald defended the Hochul administration's 2023-24 health budget against criticism that it shortchanges safety-net hospitals, citing $200 million in Statewide III awards distributed the week of the hearing and a 286 percent increase in safety-net hospital funding since 2020. But Sen. Zellnor Myrie, whose Brooklyn district includes four safety-net hospitals serving predominantly Black and brown patients, pressed McDonald on why the budget offers only one-time allocations rather than structural support, questioning why safety-net hospitals must make the case for funding annually while affluent hospitals do not. "We need structural reform, not a one-time shot," Myrie said. "Why is there nothing in the budget for them?" Medicaid Director Amir Bassiri responded that the state is allocating $2 billion for distressed hospitals and implementing a permanent methodology to keep health centers whole, assuring the Legislature that "we are not expecting any closures." The administration highlighted a 5 percent Medicaid rate increase—the largest in 20 years—and investments in primary care access, including increased reimbursement rates benchmarked to 80 percent of Medicare rates. The budget also includes $1.7 billion for a new Wadsworth Labs facility in Albany, $7.6 million for EMS resources, and over $18 million for ambulance provider rates. Coverage expansions totaling $100 million will extend Medicaid eligibility to all adults and expand doula services for pregnant and postpartum individuals. The administration proposed banning flavored tobacco products, including menthol, citing tobacco companies' targeting of Black and Hispanic New Yorkers. Department of Financial Services Superintendent Adrienne Harris reported that DFS returned $151 million to New Yorkers in restitution in 2022, more than double the prior year, and has hired 194 new staff since January 2022 to address historic understaffing. Harris requested continued FY '24 funding to combat attrition to federal regulators who pay 30-50 percent more. Assemblywoman Amy Paulin, chair of the Assembly Health Committee, questioned the administration on workforce shortages affecting nursing, EMS workers, and home care aides. McDonald noted a $3-per-hour increase for home care workers and emphasized the need for nursing faculty to expand the pipeline, while advocating for interstate nursing licensure compacts to ease workforce mobility. The hearing, held February 28 in Albany, was the 11th of 13 joint fiscal committee hearings on the executive budget. NEW YORK STATE SENATE FINANCE COMMITTEE EXAMINES 2023-2024 HEALTH BUDGET PROPOSALS Albany — The New York State Senate Finance Committee held a joint legislative hearing on February 28, 2023, to examine the Governor's 2023-2024 Executive Budget proposals on health, with testimony from Acting Health Commissioner Dr. Robert McDonald and Department of Financial Services Superintendent Linda Harris revealing significant initiatives on maternal health, long-term care insurance, and prescription drug pricing. Acting Commissioner McDonald announced that the Executive Budget would make doula care Medicaid-reimbursable at $1,500 per pregnancy and postpartum period, a substantial increase from a $600 pilot program that enrolled approximately 50 doulas in Erie County. The proposal drew strong support from Sen. Brouk, who highlighted New York's poor maternal mortality rankings—25th among states—and noted that Black women in New York City are nine times more likely to die in childbirth. Sen. Brouk urged faster implementation and suggested even higher reimbursement rates of $1,900 to ensure equitable compensation. Superintendent Harris testified extensively on long-term care insurance premium increases, a national crisis driven by decades-old actuarial assumptions. He advocated for the Governor's proposed health guarantee fund, noting that New York is the only state without such protection. Harris disclosed that the state currently has one long-term care company in rehabilitation affecting over 600 New Yorkers, with 70 currently receiving care. "Those 70 New Yorkers who are currently on claim would be forced to find care elsewhere," Harris warned, noting the average age of affected policyholders is 82 years old. On prescription drug pricing, Harris outlined a five-part plan requiring manufacturers to disclose price increases in advance and expanding oversight of pharmacy benefit managers and related entities. The Drug Accountability Board, which investigates price spikes of 50 percent or more annually, has completed one investigation to date. Medicaid Director Amir Bassiri detailed the NYRx pharmacy carveout program, which will cover 100 percent of FDA-approved drugs for Medicaid recipients—a significant expansion from managed care plans that average 64 percent coverage for diabetes medications. The program affects approximately 250,000 patients, or 3 percent of the state's 7.8 million Medicaid enrollees. Several senators raised concerns about implementation and equity. Sen. Gallivan, ranking member on Health, pressed for transparency in distributing $800 million in pandemic relief funds to hospitals, noting none had been distributed yet. Sen. Hinchey raised alarm about rural health infrastructure, citing a case where a business waited over a year for Department of Health approval in the Oneonta region, which has only three inspectors for three counties. Sen. May questioned whether tribal health clinics—including Onondaga, Tuscarora, and Tonawanda—would receive adequate funding to meet state treaty obligations, noting they are forced to close weekly due to staffing shortages. Sen. Helming, ranking member on Insurance, expressed concern that the 340B drug discount program carveout could harm rural Federally Qualified Health Centers that depend on the program. She also noted that the Rural Ambulance Task Force, created by law in 2021, was not convened in 2022 and has met only once in 2023, with a report due by December. The hearing underscored tensions between expanding health coverage and managing costs, with particular focus on rural healthcare infrastructure, long-term care sustainability, and ensuring that increased funding reaches frontline providers and workers. NEW YORK STATE SENATE FINANCE COMMITTEE EXAMINES 2023-2024 HEALTH BUDGET AMID CONTROVERSY OVER MEDICAID TRANSPORTATION, DRUG PROGRAMS, AND COUNTY FUNDING Albany — State legislators sharply questioned health department officials on Tuesday over several controversial proposals in the Governor's 2023-2024 Executive Budget, with particular focus on a billion-dollar non-emergency medical transportation contract awarded to a company with no prior experience in the field and concerns about potential pay-to-play dynamics. Assemblyman Gandolfo raised allegations that Medical Answering Services, which was awarded the statewide NEMT broker contract in summer 2022, has no experience with capitated or at-risk arrangements and that the company's owner donated hundreds of thousands to the Governor and held a fundraiser during the RFP blackout period. Medicaid Director Bassiri denied any gubernatorial interference with the procurement process and defended the vendor's qualifications, noting the department is implementing a phased approach beginning with non-MLTC populations. Senator Liu expressed frustration with the Department of Financial Services' lack of progress on a commuter van subsidy program, noting that despite pledging to prioritize the issue, Superintendent Harris made no mention of it in her testimony. "DFS continues to be the single biggest driver behind causing failure of the commuter van industry," Sen. Liu said, pressing for concrete timelines. Harris acknowledged the RFP is live but said it closes next month. Several senators challenged the pay-and-resolve proposal, which would allow health insurers to pay emergency admission claims without waiting for medical necessity determinations. Senator Helming cited DFS data showing that medical necessity denials accounted for less than 1 percent of the 104 million claims received in Q1 2022, questioning why the state would "fix something that doesn't seem broken." Senator Rhoads noted the proposal would extend resolution timelines from 90 days to 10-14 months, asking: "How does that aid consumers in any way?" The 340B drug program carveout, scheduled for April 1st, drew passionate testimony from Assemblyman Bronson, who invoked the AIDS crisis while defending the 250,000 Medicaid members who rely on wraparound services like housing and mental health support. Bassiri assured legislators the state is ready operationally and pledged federal funding would be secured. Home care worker wages emerged as another flashpoint. Assemblywoman Kelles cited data showing 43 percent of surveyed home care agencies are declining new cases and 17 percent are considering closure, while some insurers offered wage increases as low as 20 to 50 cents per hour despite the state's $3-per-hour increase mandate. Bassiri said the department would increase auditing through the Medicaid Inspector General to ensure funds reach workers. Senator Rhoads warned that the Governor's decision to withhold eFMAP federal COVID relief funds from counties will "lead directly to property tax increases," calling the position "disgraceful." He noted that in Nassau County, every dollar of property tax revenue goes to Medicaid. Acting Health Commissioner McDonald outlined pandemic preparedness investments, including staffing increases in epidemiology and creation of a new Division of Vaccine Excellence to combat vaccine misinformation. She also described the budget's lead poisoning prevention proposal as "historic," targeting 24 high-risk municipalities representing 80 percent of cases. The hearing, held jointly by the Senate Finance Committee and Assembly, featured testimony from DFS Superintendent Harris, Medicaid Director Bassiri, and Acting Health Commissioner McDonald on February 28, 2023. New York State health officials faced sharp questioning from legislators on Tuesday over Medicaid funding structures, nursing home reimbursement rates, and coverage gaps for vulnerable populations during a joint legislative hearing on the 2023-2024 Executive Budget. Medicaid Director Bassiri defended the state's approach to county cost-sharing, asserting that New York has absorbed all Medicaid growth since 2015 and that counties have had no administrative responsibility since the pandemic emergency declaration in March 2020. However, Sen. Borrello, drawing on 10 years in county government, challenged the arrangement, arguing that New York unfairly burdens counties with costs while the state controls eligibility and benefits. "If New York State controls who's eligible and what benefits they receive... then how is it we justify taking federal money away from counties to fill that gap?" Borrello asked. Assemblywoman Lunsford testified that the Executive Budget's proposed 5 percent Medicaid rate increase for nursing homes is insufficient, noting that Monroe County alone has 1,000 beds offline due to a $165-$200 daily reimbursement gap. She warned that some nursing homes may not survive the year without additional support. Bassiri characterized the increase as "the largest investment we've made for nursing homes since I can remember," citing $1.5 billion in workforce bonuses and $1.5 billion allocated through a federal waiver for distressed facilities. Sen. Gustavo Rivera pressed officials on delayed reports to the Legislature, noting that multiple reports due months ago were delivered last night. He also questioned the permanence of proposed 340B drug program relief for safety-net hospitals, asking whether statutory protections would be stronger than state plan amendments. Rivera expressed skepticism about the state's commitment to immigrant health coverage, noting that Colorado and Washington have implemented similar programs. Assemblywoman González-Rojas challenged the administration's reluctance to submit a federal 1332 waiver to expand Essential Plan coverage to undocumented immigrants, noting 300 public comments in support. Bassiri cited federal funding constraints, stating that pass-through funds of roughly $2 billion annually would be insufficient for an estimated 245,000 undocumented enrollees. González-Rojas requested the administration assess public comments and reconsider the proposal. DFS Superintendent Harris reported that the department returned $151 million to New Yorkers in 2022, double the prior year, through its Consumer Assistance Unit of 42 staff handling 56,000 complaints annually. She requested additional funding and FTEs to improve response times to consumer complaints about insurance companies. Assemblywoman Byrnes raised concerns about regional equity in the Health Care Facility Transformation Program, noting that Westchester County received $70 million in Round III while the Finger Lakes region, with more residents, received only $21 million. Harris announced that $200 million in additional awards were announced this morning, with $50 million directed to the Finger Lakes region. Chair Krueger sought clarification on Medicaid reimbursement rates for reproductive health services and pressed officials on hospital pricing transparency, noting that price variations for identical procedures across hospitals remain unexplained. She questioned whether the state has objective data on appropriate pricing and whether Medicaid reimbursement rates for safety-net hospitals are adequate compared to commercial rates. NEW YORK STATE SENATE AND ASSEMBLY COMMITTEES ON FINANCE HEARING — February 28, 2023 New York's hospitals and nursing homes are in structural fiscal crisis, with four out of five facilities reporting unsustainable financial margins, according to testimony at a joint legislative hearing on the 2023-2024 Executive Budget for health and Medicaid spending. The primary culprit, witnesses said, is chronic underpayment by Medicaid. Kenneth Raske of the Greater New York Hospital Association stated that New York reimburses hospitals at 61 cents on the dollar of cost—the worst rate among all 51 U.S. jurisdictions. Bea Grause of the Healthcare Association of New York State echoed the assessment and requested a minimum 10 percent Medicaid rate increase for both hospitals and nursing homes. A separate controversy emerged over managed long-term care plan profits. Assemblywoman Jo Anne Simon pointed out that 25 plans reported $722 million in profit in 2021—money she argued should fund home care worker wages instead. Medicaid Director Bassiri agreed the state is "not okay" with plans retaining such profits. Senator Gustavo Rivera pressed Acting Commissioner McDonald on why $187 million in nursing home safe staffing funds, appropriated in a prior budget, have not been distributed. Bassiri said the state is seeking federal approval for a new distribution methodology and committed to funding the state share regardless. Rivera also challenged the administration on its claim that opioid settlement dollars cannot legally fund overdose prevention centers. Commissioner McDonald acknowledged the issue is "complicated" but said it is "not legal in New York," prompting Rivera to demand the administration specify what legal restrictions actually apply. The pharmacy carveout proposal drew opposition from Jacquelyn Kilmer of the Save New York's Safety Net Coalition, which serves 2.3 million community members. She warned that the Executive Budget's proposed solution—a pool of money subject to budget negotiations and federal approval—is unreliable and urged adoption of Senator Rivera's alternative bill, S5136, which would maintain the 340B reimbursement mechanism. Hospital groups supported the budget's pay-and-resolve and site-of-service proposals as ways to address insurer abuses, though Senator Helming sought clarification that pay-and-resolve would not delay payments. Grause confirmed it would not, requiring payers to pay within 30 days for emergency and inpatient services. Assemblyman Weprin advocated for a 20 percent Medicaid increase and asked Raske to provide a state-by-state ranking of Medicaid reimbursement rates. Raske committed to sharing a study from a Cornell professor ranking all 51 jurisdictions. Other issues raised included the status of $11.2 million in annual funding for the dollar van industry (funds not yet expended pending an RFP), concerns about travel nurse regulation and geo-boundaries, and questions about home care worker wage standards. Commissioner McDonald acknowledged home care is healthcare but declined to specify a wage target, saying the state would "see what's possible" in future budgets. Hospital and health center representatives testified before the Joint Legislative Committee on Finance on February 28 that the Governor's proposed 2023-2024 health budget would leave struggling providers worse off despite a 5 percent Medicaid rate increase, the first in 15 years. The centerpiece of their opposition was the proposed 340B pharmacy program carveout, which they said would eliminate $260 million in savings that community health centers and hospitals use to fund uncompensated care, mobile clinics, school-based health services, and programs serving uninsured and underinsured populations. Ken Raske of the Greater New York Hospital Association testified that the 340B carveout "washes out" the Medicaid increase, resulting in "net zero" benefit. Bea Grause of the Hospital Association of New York State warned of a "structural fiscal crisis" with expenses exceeding revenues month after month, leading hospitals to cut clinic hours and other services. The testimony revealed a healthcare system under severe strain: 8 million Medicaid members face recertification, nursing homes have closed more than 2,000 beds due to staffing shortages, and hospitals are paying three times the hourly rate for traveling nurses compared to permanent staff. Chairwoman Liz Krueger pressed testifiers on a puzzling workforce paradox: New York has 355,000 licensed nurses but only 188,000 working as nurses, yet hospitals claim severe shortages. She criticized "range wars" between hospitals competing for nurses and called for systemic solutions. Community health center representatives testified they serve 2.3 million New Yorkers, 60 percent on Medicaid, and rely on 340B savings to serve an uninsured population 2.5 times the state average. Louise Cohen of the Primary Care Development Corporation noted that primary care receives only 5-7 cents per healthcare dollar, far below the 12-14 cents in other industrialized countries, and warned that the 340B carveout creates long-term lending problems for community providers. The hearing highlighted deep disagreements between the Cuomo administration and the healthcare industry over budget priorities, with providers requesting restoration of $700 million in safety-net cuts, elimination of the 340B carveout, and modernized Medicaid rates based on current costs rather than 1999-2000 baselines. NEW YORK STATE SENATE FINANCE COMMITTEE — Advocates and health plan representatives clashed with state budget proposals during a joint legislative hearing on the 2023-2024 Executive Budget on Health, with particular intensity over coverage for undocumented immigrants and elimination of quality incentive programs. Testifiers from Health Care for All New York and New York Lawyers for the Public Interest argued that the state's $2 billion surplus would be sufficient to cover approximately 245,000 undocumented immigrants, with potential offsets of $500 million in emergency Medicaid savings. Amanda Dunker of the Community Service Society presented data showing stark medical debt disparities: 27 percent of Chemung County residents and 26 percent of residents in majority-people-of-color zip codes in Onondaga County carry medical debt in their credit reports, compared to 6 percent statewide. Karina Albistegui Adler of New York Lawyers for the Public Interest presented a case study of an undocumented dialysis patient unable to access kidney transplant due to lack of insurance, calling coverage expansion "a life-and-death situation." She noted that undocumented New Yorkers are registered organ donors but among the least likely to receive transplants. Health plan representatives opposed multiple budget proposals. Eric Linzer of the New York Health Plan Association disputed state cost estimates on the pharmacy carveout, citing a Wakely Consulting analysis showing the proposal would increase state costs by $235 million annually, not the $420 million in savings the state claims. He also warned that the "pay-and-pursue" provision would create a cumbersome 10-month recoupment process, increasing costs for employers and consumers. Dr. Tayla Schwartz of MetroPlus Health Plan warned that launching the pharmacy carveout simultaneously with Medicaid redetermination for 9 million New Yorkers would create operational chaos, with MetroPlus alone facing 50,000 monthly redeterminations. She also opposed elimination of the Quality Incentive Program, which funds $110 million in provider reimbursement and community-based initiatives including housing support for homeless members. Chairwoman Liz Krueger expressed strong support for primary care expansion, citing research showing that larger investments in primary care reduce hospital visits and emergency room utilization while lowering overall costs. She noted that New York's policies appear "in reverse" compared to evidence-based practices. Sen. Gustavo Rivera pressed testifiers on the urgency of coverage expansion, expressing shock that the Medicaid director had not provided mathematical analysis supporting claims that the waiver would be too expensive. The hearing revealed significant disagreement between state officials and advocates over both the feasibility and cost-benefit of proposed healthcare policy changes. NEW YORK STATE SENATE FINANCE COMMITTEE HEARS COMPETING VISIONS ON MEDICAID SPENDING IN 2023-2024 BUDGET Albany — The New York State Legislature's Joint Finance Committee heard sharply divergent testimony on the 2023-2024 Executive Budget's health provisions on Tuesday, with advocates for expanded coverage clashing with fiscal conservatives warning of unsustainable spending growth. Chairwoman Lois Krueger and committee members heard testimony from local health officials, Medicaid beneficiaries, policy analysts, and community health advocates regarding proposed changes to Medicaid, lead prevention, tobacco control, and services for vulnerable populations. Advocates pushed for the "Coverage for All" proposal to extend comprehensive healthcare coverage to undocumented immigrants, arguing it would save the state money by shifting from emergency Medicaid to full coverage. Ms. Albistegui Adler of New York Lawyers for Public Interest cited California's expansion of its Medi-Cal program beginning in 2024 as a model. Dr. Irina Gelman, representing New York's 58 local health departments, requested a significant increase in lead prevention funding from the proposed $18 million to $58 million, citing a 2019 unfunded mandate that impacted 12 counties. She also advocated for extending the Governor's tobacco control package to include flavored cannabis products, noting enforcement challenges at the local level. Lara Kassel of Medicaid Matters New York, a 20-year-old coalition representing Medicaid beneficiaries, shared personal testimonies of how coverage enabled access to critical care, including rare disease diagnosis and reproductive health services. She advocated for Fair Pay for Home Care, raising asset limits, and increased transparency in Medicaid programs. Bill Hammond of the Empire Center struck a cautionary note, warning that New York's Medicaid spending—set to break $100 billion this year—is growing unsustainably. He noted that the state's share has increased 20 percent since the pandemic, with another 9 percent increase proposed. Hammond cited data showing New York's per-capita hospital spending is the highest in the country and rising fastest, jumping from 22 percent above the national average in 2015 to 43 percent above in 2020. Charles King of Housing Works and the Ending the Epidemic Community Coalition testified about the pharmacy carveout from managed care, warning it would harm Federally Qualified Health Centers and Ryan White providers. He opposed the Governor's plan to cut $100 million from the Health Home program over two years and roll 70,000 participants off the program with time limits of 9-12 months. King also highlighted that two overdose prevention centers saved more than 250 lives over 14 months and advocated for enhanced rental assistance for people with HIV living outside New York City. Sen. Krueger challenged Hammond on whether the Empire Center conducts observational evaluation in communities or relies solely on numerical analysis, signaling skepticism about purely data-driven arguments for reduced spending. She also pressed for details on lead prevention funding needs and cannabis licensing oversight coordination with local health departments. The hearing underscored fundamental disagreements about Medicaid's role and sustainability, with advocates emphasizing coverage expansion and equity while fiscal conservatives warn of unsustainable growth in a program already consuming an outsized share of state resources. NEW YORK STATE SENATE FINANCE COMMITTEE HEARS COMPETING CLAIMS ON HEALTH BUDGET PRIORITIES Albany — A joint legislative hearing on the 2023-2024 Executive Budget's health provisions revealed sharp divisions Tuesday between nursing home industry representatives and patient advocates over the adequacy of proposed Medicaid reimbursement increases, while testimony on early childhood intervention services highlighted a separate crisis of provider shortages and service delays. The nursing home industry requested a 20 percent Medicaid rate increase, arguing that New York leads the nation in underfunding long-term care. Stephen Hanse, president and CEO of the New York State Health Facilities Association, testified that the statewide average Medicaid reimbursement of $211 per resident per day falls far short of the actual $265 daily cost of care — equaling just $8.79 per hour, below minimum wage. The industry cited 6,600 closed nursing home beds that cannot be staffed due to inadequate compensation. However, Stefan Foster of the Long Term Care Community Coalition disputed the industry's claims of underfunding, characterizing them as "fiction" and arguing that nursing homes use related-party transactions to hide profits rather than invest in care. Foster cited recent lawsuits by the New York Attorney General alleging fraudulent financial practices, including one case where a facility allegedly paid a related party over $15 million in fraudulent rent costs. The Governor's budget proposes a 5 percent Medicaid increase for nursing homes, which the industry says falls short of the 43 percent increase needed to recover from 15 years of cuts. Jim Clyne of LeadingAge New York warned that without significant increases, the long-term care crisis will continue to ripple through the entire healthcare system, with hospital emergency rooms backing up because patients cannot be discharged to nursing homes. Separately, testimony on the Early Intervention Program revealed a crisis in developmental services for infants and toddlers. Steven Sanders of Agencies for Children's Therapy Services cited a recent State Comptroller report finding that over half of enrolled children do not receive all diagnosed services, and over a quarter experience delays beyond statutory timelines. Sanders attributed the crisis to stagnant reimbursement rates lower than 2009 levels, which have driven 1,800 therapists from the field and caused 65 agencies to close in four years. Brigit Hurley of The Children's Agenda presented the case of a 2-year-old who has waited over a year for speech therapy services, noting that such delays during critical brain development periods have long-term consequences. The Children's Agenda requested an 11 percent rate increase for Early Intervention services. Sanders identified $40 million in unallocated funds from a commercial insurance assessment that he argued should be reinvested in rate increases. The funds resulted from legislation, sponsored by Assemblywoman Paulin, that shifted from billing commercial insurance (which paid only $12 million annually on a $700 million program) to assessing insurers their fair share. Testimony on home care services highlighted tensions between expanding eligibility and cutting provider wages. Bryan O'Malley of the Consumer Directed Personal Assistance Association criticized the budget for removing wage parity protections for home care workers, arguing it would devastate the workforce during a crisis. Heidi Siegfried of the Center for Independence of the Disabled warned that unimplemented Medicaid Redesign Team cutbacks on home care eligibility could force thousands into nursing facilities once federal FMAP funding expires. Sen. Luis Rivera pressed witnesses for clarification on competing claims, distinguishing between industry advocacy and patient advocacy organizations, and probing emerging policy issues including health homes and eligibility changes for activities of daily living services. The hearing underscored the state's struggle to balance competing demands across the healthcare system with limited resources, with advocates and providers offering starkly different assessments of both the adequacy of current funding and the causes of service delivery failures. NEW YORK — Healthcare advocates, union representatives, and medical professionals testified before the Senate Finance Committee on Tuesday that New York's 2023-2024 health budget fails to adequately address critical workforce shortages and service access gaps, particularly in Early Intervention programs and home care. The most urgent crisis centers on Early Intervention services for infants and toddlers. Testifiers emphasized that one million neural connections form per second in early childhood, making the first three years of life irreplaceable. Yet the program is collapsing: since 2019, more than 1,800 therapists and providers have left the program and 65 agencies have closed, according to Steve Sanders, an Early Intervention advocate. Early Intervention rates in 2023 are lower than in 2009, he said. The Children's Agenda's Brigit Hurley testified that providers are not reimbursed for travel time, mileage, or coordination work, forcing many to operate at a loss. She noted that 12 students from Nazareth College testified they have no incentive to enter Early Intervention due to low pay compared to other healthcare settings. A Comptroller's audit cited in testimony found that service delays and denials are "particularly more acute in minority communities," according to Sanders. Home care workers face similar crises. Bryan O'Malley testified that unmet demand for home care aides is in the thousands and growing, while home care costs tens of thousands of dollars less per year than nursing home care. He warned that the Governor's proposed minimum wage increase, which removes wage indexing for home care workers, would undercut recent wage gains and worsen the shortage. Pharmacies are also in crisis. Dr. Heather Ferrarese of the Pharmacists Society of New York testified that pharmacies are supposed to receive $10.18 per prescription under state law but actually receive 50 cents, forcing independent pharmacies to subsidize the Medicaid program. She opposed a compromise bill (S5136) setting the fee at $8.50, calling instead for full fee-for-service implementation on April 1st. Sen. Rivera, who introduced S5136, said he remains open to modifications if pharmacists believe stronger protections are needed. Union representatives from CWA, NYSNA, and 1199 SEIU called for substantial Medicaid rate increases—10 percent for hospitals and 20 percent for nursing homes—noting that rates have not been raised for 15 years despite exponential cost increases. Helen Schaub of 1199 SEIU, representing 350,000 healthcare workers, said workers are leaving healthcare because they cannot provide the care they know patients deserve when working short-staffed. Sen. Krueger, the committee chair, expressed frustration that the state continues to fail Early Intervention children year after year, questioning the Department of Health's claim that parental consent is the reason for service delays. Sen. Brouk emphasized that service failures have consequences 5, 10, 15, and 35 years later when children are in school and the workforce. The Medical Society of New York opposed Part W provisions that would expand the scope of practice for physician assistants and pharmacists, arguing that physician oversight is essential for patient care coordination. NEW YORK STATE SENATE FINANCE COMMITTEE HEARS HEALTH BUDGET TESTIMONY ON MANAGED CARE, WORKFORCE, AND TOBACCO POLICY Albany — The New York State Senate Finance Committee held a joint hearing on the 2023-2024 Executive Budget on Health on Tuesday, hearing testimony on managed long-term care reform, healthcare workforce shortages, scope of practice expansion, reproductive healthcare access, hospice services, cancer screening, and tobacco regulation. A key point of contention emerged around New York's managed long-term care system for personal care services. A testifier identified as Ms. Schaub argued that the state's 10-year-old shift to managed long-term care has failed to deliver promised savings and efficiency. She stated that utilization has "exploded," costs have increased significantly, and only 17 percent of the population is enrolled in fully dual-eligible plans. She proposed switching to a managed fee-for-service model similar to Washington and Connecticut, claiming the state could save $1.5 to $3 billion annually while improving transparency and reducing administrative overhead. The nursing workforce shortage generated significant debate. Mr. Mathew from the New York State Nurses Association challenged the premise of a shortage, stating that 170,000 licensed nurses in New York are not working in the state due to poor working conditions rather than lack of supply. He cited Montefiore as an example, noting open positions increased from fewer than 300 three years ago to over 700 currently. Ms. Hayes testified that vaccine mandates contributed to workforce losses, with one health system losing 300 employees, including 150 nurses. Chair Krueger raised a critical question about the paradox of nursing shortages: New York has 355,000 licensed nurses with 188,000 working as nurses, yet hospitals employ expensive traveling nurses at three times the cost. Ms. Schaub responded that staffing agencies have created a self-perpetuating cycle by recruiting permanent staff to temporary positions, forcing institutions to pay premium rates to maintain minimum staffing levels. She supported the Governor's proposal to regulate staffing agencies and suggested other states have capped agency fees or restricted non-compete clauses in contracts. Dr. Pipia testified against expanding scope of practice for physician assistants, nurse practitioners, and pharmacists, arguing that physicians should lead healthcare teams. He cited an AMA study showing non-physicians order more tests than physicians and highlighted New York's unfriendly environment for physicians, including malpractice costs of approximately 24 compared to 2.46 in Texas—roughly 12 times higher. On reproductive healthcare, Ms. Hanson from Planned Parenthood Empire State Acts testified that medication abortion comprises over 60 percent of abortions provided by New York affiliates, yet reimbursement rates are significantly lower than other states. She requested rate increases to at least $550 for medication abortion visits, plus $25 million in grant funding for abortion providers and $1 million for abortion funds. Ms. Chirico from the Hospice and Palliative Care Association reported implementation problems with hospice legislation passed last year. A Department of Health "Dear Administrator" letter created confusion regarding hospice services in assisted living programs, resulting in no individuals in those settings receiving hospice services. She requested $400,000 for an office of hospice and palliative access and quality and $2 million for an advanced care planning campaign, noting New York ranks last in the country in hospice utilization. Mr. Davoli from the American Cancer Society testified that over 30,000 New Yorkers are diagnosed annually with breast, cervical, and colorectal cancers, yet the Cancer Services Program serves only 18 percent of eligible population. He requested restoration of the CSP budget to $26.8 million and highlighted that 28,200 New Yorkers die annually from tobacco-related illness—26.7 percent of all cancer deaths in the state. A contentious exchange occurred over tobacco regulation. Mr. Hudgins from the National Hookah Community Association requested exemption of hookah from the Governor's proposed flavored tobacco ban, arguing hookah is a cultural product with centuries of history, comprises only 0.005 percent of nicotine sales, and has low youth usage rates (1 percent of middle and high school students). He noted that California and multiple other jurisdictions have exempted hookah from flavored tobacco bans. Mr. Davoli questioned the historical claim about flavored hookah, noting the tobacco industry only discusses flavoring in the past 60 years. Chair Krueger noted that New York City already prohibits flavored hookah, and questioned whether the Governor's proposal would meaningfully change the situation outside the city. Mr. Hudgins disputed that "things have been going okay" under the current ban, citing reluctance from immigrant communities to engage with government enforcement. Assemblyman Sayegh, citing his Middle Eastern background, expressed concern that the hookah ban unfairly targets certain communities while allowing cigarettes and cannabis, and warned that bans would drive the market underground, eliminating tax revenue and creating unmonitored products. NEW YORK — Advocates for tobacco regulation and abortion access testified before the state Legislature on Tuesday regarding the 2023-2024 Executive Budget on Health, raising concerns about both public health priorities and the adequacy of proposed state funding. Mr. Davoli of the American Cancer Society urged lawmakers to ban flavored tobacco products, arguing that the tobacco industry deliberately uses flavors to target vulnerable populations. He cited data showing women smoke menthol cigarettes nearly three times as much as men, and said the industry has conducted decades-long campaigns targeting communities of color and LGBT populations with free menthol cigarettes and targeted advertising. "These products are used to hook people," Davoli testified, noting that cancer patients from across New York State die daily from tobacco-related illnesses. On abortion access, Georgana Hanson of Planned Parenthood testified about the Governor's proposed $25 million in funding for abortion care, but raised concerns about how the money would be allocated. She said the current budget language may limit funding to providers rather than also supporting practical services for patients seeking abortion care, such as travel assistance, lodging, childcare, and translation services. Hanson noted that barriers to abortion access—including cost, time off work, and childcare arrangements—existed even before the Supreme Court overturned Roe v. Wade last summer, and that 18 states have now severely banned or restricted abortion access. Handson also highlighted capacity challenges facing abortion providers, saying that staffing costs are rising and it is increasingly difficult to attract and retain workers, particularly at smaller safety-net providers like Planned Parenthood. She warned that underinvestment in provider capacity directly impacts New Yorkers seeking abortion care. The hearing, chaired by Sen. Krueger, concluded at 6:16 p.m. Follow-up hearings on housing and workforce development are scheduled for the following day.