FINANCE

NEW YORK STATE LEGISLATURE OPENS 2024-2025 BUDGET HEARINGS WITH HEALTH FOCUS Albany — The New York State Senate Finance Committee and Assembly Ways and Means Committee convened their first joint budget hearing of the year on Tuesday to examine Governor Hochul's proposed 2024-2025 spending plan for health and financial services, with testimony emphasizing workforce shortages, hospital funding, and insurance regulation challenges. Dr. James V. McDonald, commissioner of the Department of Health, outlined an ambitious agenda centered on what he called "stewardship" during a fiscally constrained year. The department is requesting an additional $984 million for distressed hospitals—bringing total funding for such institutions to nearly triple the 2021 level—and will pursue a $7.5 billion Medicaid waiver that includes $6 billion in new federal funding to address health inequities. McDonald highlighted several workforce initiatives, noting that New York lags behind most states in healthcare professional licensing compacts. "We're one of only 11 states that hasn't joined the Physician Licensure Compact; one of only nine states that hasn't joined the Nurse Licensure Compact," he said, adding that New York is the only state prohibiting medical assistants from administering vaccines. He called for legislative changes to outdated laws restricting healthcare workers' scope of practice. On insurance expansion, McDonald announced that a pending 1332 innovation waiver will raise Medicaid eligibility from 200 to 250 percent of the federal poverty line, potentially covering an additional 100,000 New Yorkers. The budget also proposes eliminating cost-sharing for office visits, lab work, and pharmaceuticals for chronic conditions in both the Essential Plan and qualified health plans. Maternal health received significant attention, with $700,000 allocated to the Perinatal Quality Collaborative and new doula coverage for Essential Plan enrollees. The department will also seek continuous Medicaid coverage for children up to age six, eliminating administrative burden for an estimated 650,000 children currently enrolled. Adrianne Harris, superintendent of the Department of Financial Services, reported transformative progress since her arrival two years ago. The department has implemented 100 amendments to financial services laws, issued 60 pieces of regulatory guidance, and secured $344.4 million in restitution for consumers. DFS has hired 336 new employees and promoted 309 existing staff members, bringing the agency to full funding for the first time in its history. Harris emphasized three pillars of DFS's transformation: policy, process, and people. On regulation, she highlighted the successful licensing of every pharmacy benefit manager operating in New York by January 1, 2024, and announced that market conduct rules for PBMs would be reproposed "within weeks" after stakeholder engagement. She also noted DFS's expanded virtual currency regulatory team, which grew from a handful of employees to more than 60 experts. Senator Neil Breslin, chair of the Insurance Committee, praised the superintendent's collaborative approach with the Legislature, contrasting it with past adversarial relationships. He pressed Harris on low-income housing insurance discrimination, PBM market access for independent pharmacies, and the long-term care insurance crisis—a nationwide problem where products were "mispriced" decades ago and rates kept artificially low for political reasons. Harris acknowledged the long-term care challenge, noting that DFS works to phase in rate increases over time and allows consumers to choose between increases or benefit reductions. She also highlighted the department's role in managing the 2023 banking crisis, during which DFS worked around the clock to prevent financial contagion following the failures of Silicon Valley Bank and other institutions. The hearing marked the first of 13 budget hearings scheduled by the joint fiscal committees. Commissioner McDonald noted the need to identify $200 million in savings in long-term care and Medicaid, signaling difficult negotiations ahead with the Legislature. New York State health officials defended Governor Hochul's 2024-2025 executive budget proposal during a joint legislative hearing on Tuesday, facing pointed criticism from lawmakers over $400 million in unallocated Medicaid cuts and reductions to healthcare provider funding amid a broader fiscal crisis. Medicaid Director Amir Bassiri explained that the $400 million reduction—$200 million from long-term care and $200 million from general services—is necessary to align spending with the statutory 6.7 percent growth rate, as Medicaid is currently growing at nearly 11 percent. However, Bassiri acknowledged the department has no predetermined proposals for where cuts will be made, saying the administration will work with the Legislature to identify savings by April 1. Senator Cathleen Helming, the Insurance Committee ranker, raised alarm about rural healthcare access, citing an Urban Institute study showing that Federally Qualified Health Center costs are 44 percent higher than maximum Medicaid reimbursement rates. She also criticized proposed changes to physician malpractice insurance, noting that New York already has the highest cumulative medical liability payments in the nation—68 percent more than Pennsylvania—and questioned how such changes would incentivize doctors to practice in the state. Senator Michelle Hinchey highlighted a hospital funding crisis, noting that 75 of 261 New York hospitals are financially distressed with an unmet need of $1 billion to $1.5 billion. She questioned whether the $984 million in available hospital support would reach hospitals on the brink of distress that don't currently qualify for 1115 waiver funding. DFS Superintendent Adrienne Harris defended the administration's insurance market reforms, including a proposal to eliminate cost-sharing for insulin prescriptions, which she estimated would have a minimal premium impact of 0.03 to 0.04 percent. She cited studies from other states showing that zero cost-sharing for insulin increases medical compliance and can result in up to 18 percent in overall cost savings. Commissioner of Health James McDonald addressed the opioid epidemic, emphasizing that illicitly obtained fentanyl—not legally prescribed drugs—is driving overdose deaths. He outlined budget proposals to expand access to buprenorphine, including a three-day supply amendment aligned with federal policy changes, and noted the department is deploying over $7.5 million from the JUUL settlement for vaping prevention campaigns targeting youth. Assemblyman Ed Ra criticized the late release of a managed care procurement report, which was released the day before the hearing despite being dated October 2023. The proposal estimates $300 million in Medicaid savings through administrative efficiency gains. Lawmakers also raised concerns about cuts to public health programs, nursing home staffing compliance funding that has not been fully released, and the elimination of the $6 million EQUAL Program for assisted living. The hearing underscored deep tensions between the administration's fiscal constraints and legislative demands to protect healthcare providers and vulnerable populations. NEW YORK STATE LEGISLATURE — Lawmakers sharply questioned state health officials on Tuesday over proposed Medicaid cuts, maternity service closures, and inadequate reimbursement rates for nursing homes and home care workers during a joint legislative hearing on the 2024-2025 executive budget. The hearing before the Finance Committee revealed significant tensions between the Governor's budget proposals and legislative concerns about healthcare access, particularly in rural areas and for vulnerable populations. Senator John Liu pressed DFS Superintendent Adrienne Harris on whether the agency was truly performing flawlessly, noting that a $163 million return to consumers and healthcare providers appeared to benefit providers more than consumers. Harris acknowledged the agency still faces significant backlogs, with 11,000 old filings processed in the past year through expedited 60-day lists. Senator Zellnor Myrie expressed frustration that Commissioner of Health Mary Ellen McDonald failed to deliver a statutorily required report on health inequities in Central Brooklyn despite multiple promised deadlines. Myrie noted the report was due in October 2023, then promised for January 2024, with only eight days remaining in the month. He also criticized the lack of communication between the Department of Health and SUNY regarding a transformation plan for SUNY Downstate, calling the situation "unacceptable." Maternity services emerged as a major concern. Assemblyman Andrew McDonald noted that 24 maternity wards have closed in the last 15 years, with five currently proposed for closure including the Burdett Birth Center in Troy. Senator Ashby pressed Commissioner McDonald on whether Trinity Health's premature closure actions and alleged falsehoods in the closure plan warranted a full regulatory review rather than a partial one. McDonald declined to discuss specifics, citing the active regulatory process, but acknowledged concern about "maternity deserts" in Hamilton and Seneca counties. Nursing home reimbursement rates drew intense scrutiny. Assemblyman Bendett noted an $810 million state share Medicaid funding gap for nursing homes and 6,000 beds taken offline over six years. Medicaid Director Amir Bassiri disputed characterizations of proposed cuts, explaining that much of the reduction involves unallocated funding that nursing homes have not claimed rather than direct service cuts. He stated no nursing homes are anticipated to close as a result of the proposed actions. Senator Brouk raised alarm about a Rochester hospital with over 100 patients ready for discharge but unable to leave due to lack of nursing home beds, saying "we're in it" regarding the crisis. She also praised the new doula care reimbursement rate but noted it fell short of the $1,930 requested by the doula community. Home care worker wages became another flashpoint. Assemblywoman Lunsford and Assemblywoman González-Rojas challenged the elimination of wage parity for home care workers, which they said represents a $2-$3 cut per hour and eliminates a $2 raise provided two years ago. Bassiri disputed the magnitude of the cut and said the workers would retain the previous $3 increase. Commissioner McDonald announced that midwife-led birthing centers are expected to open in New York State in 2024 and that coverage for undocumented immigrants age 65 and older and pregnant individuals began January 1st. She also indicated that approval of the 1332 waiver, which could extend coverage to additional undocumented immigrants and save $500 million in Medicaid spending, is expected this week. Senator Stec raised concerns about Medicare Advantage plan practices, noting that hospitals including Albany Med, Saratoga Hospital, and Glens Falls Hospital have terminated relationships with Wellcare and Humana plans. He pressed Harris on whether DFS monitors these business practices and whether insurers must notify policyholders when providers leave their networks, particularly urgent given the open enrollment period ends March 31st. NEW YORK STATE HEALTH BUDGET HEARING REVEALS DEEP TENSIONS OVER MEDICAID CUTS AND FEDERAL FUNDING Albany — A contentious joint legislative hearing on the 2024-2025 executive health budget exposed significant disagreement between lawmakers and state health officials over proposed Medicaid reductions, with senators accusing the administration of leaving hundreds of millions in federal dollars on the table while imposing cuts on vulnerable populations. Sen. José Rivera, chair of the Senate Health Committee, repeatedly pressed Commissioner of Health James McDonald and Medicaid Director Amir Bassiri on why the state is not pursuing approximately $500 million in available federal funding and nearly $800 million in additional federal resources that could support coverage expansion, particularly for undocumented immigrants. "You're leaving almost $500 million on the table," Rivera said, characterizing the budget as a troubling reversal from positive fiscal trends in prior years. The hearing revealed that New York currently spends approximately $860 million in emergency Medicaid for undocumented immigrants (state and federal combined), with the state and local share at roughly $400 million. Rivera argued this demonstrates the state is already bearing significant costs and could redirect federal resources to expand coverage rather than impose cuts. A central point of contention involved "unallocated cuts" — $400 million in Medicaid reductions and $200 million in other health cuts that the administration has not specifically designated. Rivera criticized this approach as forcing lawmakers to choose which services to cut, comparing it to "being the caterer at your own funeral." Commissioner McDonald defended the strategy as a partnership approach, but Rivera remained unconvinced. The hearing also highlighted the precarious financial state of New York's healthcare system. Assemblyman Gray noted that 75 percent of hospitals operate with negative margins and 40 percent rely on supplemental VAP or VAPAP funding. The state currently provides approximately $3 billion in subsidies to financially distressed hospitals. Despite these conditions, the budget proposes no new Medicaid rate increases for hospitals or nursing homes, drawing criticism from multiple lawmakers. Sen. Gounardes expressed frustration with what he called a perpetual "crisis to crisis" funding model for safety net hospitals, asking what structural changes the budget advances toward sustainable long-term funding. Commissioner McDonald acknowledged the problem but emphasized that solutions require cost reduction through scope of practice changes and licensure compacts, not just additional funding. Other contentious issues included proposed changes to the Consumer Directed Personal Assistance Program (CDPAP) wage parity provisions. Rivera pressed Bassiri on whether the changes would eliminate minimum wage protections for home care workers. Bassiri initially denied this, but then acknowledged the language would need to be fixed in technical amendments — a concession that drew sharp questioning about whether the changes would worsen an already severe healthcare workforce crisis. Assemblywoman Walsh delivered passionate testimony on health equity, characterizing the lack of rate increases for disability services clinics as discrimination. She noted that Center Healthcare, which serves individuals with intellectual and developmental disabilities, has not received a rate increase in 17 years while hospital-based clinics received 7 percent increases last year. She cited 600 individuals on waitlists after a hospital closed its dental clinic. On reproductive health, Sen. Webb questioned how providers can continue offering medication abortion services without adequate Medicaid reimbursement increases, noting that last year's two-year investment has been difficult to implement. The hearing also revealed a missing health equity report that Sen. Myrie had previously requested. When Rivera asked Commissioner McDonald where the report was, McDonald said he knew its location but could not produce it, citing the involvement of other agencies. Rivera pressed him to retrieve it, calling its absence problematic given the need to assess whether proposed changes address existing healthcare inequalities. On lead pipe replacement, Sen. May noted that the state has spent only $30 million of a $50 million request last year — approximately 1 percent of statewide need. Commissioner McDonald said the current budget includes $115 million and that the Governor announced additional projects, with more federal funding expected in coming years. The hearing underscored deep disagreement over budget priorities and methodology, with multiple senators signaling they will continue pressing the administration on federal funding opportunities and the rationale for unallocated cuts during the budget negotiation process. NEW YORK STATE SENATE FINANCE COMMITTEE HEARING ON 2024-2025 HEALTH BUDGET — The Senate Finance Committee held a contentious joint hearing on the Governor's health budget proposal on January 23, with lawmakers pressing administration officials on hospital sustainability, Medicaid spending priorities, and maternal health outcomes amid concerns about rising costs and inadequate services. Commissioner McDonald acknowledged that hospital labor costs—particularly expensive agency nursing—are the primary driver of the 90 percent increase in hospital spending over the past decade, but offered only long-term solutions like licensure compacts and scope-of-practice changes. When pressed by Sen. Gounardes on why corporate hospital chains are posting billion-dollar profits while costs soar, McDonald did not directly address the apparent contradiction. The hearing revealed significant tensions over Medicaid spending priorities. Medicaid Director Bassiri disclosed that the federal 1115 waiver provides $550 million annually for private financially distressed hospitals but explicitly excludes public hospitals—a limitation that drew sharp questioning from Assemblywoman Walker about safety-net hospitals like Brookdale and Interfaith that serve primarily Medicaid populations. Chairwoman Krueger raised alarm about the Medical Indemnity Fund, which provides lifetime care for children born with serious disabilities. She noted that according to the most recent available report from Q4 2022, the fund's assets-to-expense ratio was expected to hit 80 percent by mid-2023—a threshold that triggers closure discussions. Bassiri acknowledged "more money may be needed" but said there is currently "no new investment" in the fund. Krueger warned that the state faces a potential crisis if the fund runs out of money before new appropriations are made. Maternal health emerged as a flashpoint. Assemblywoman Paulin criticized New York's ranking as 49th out of 50 states for primary C-section rates and argued the administration's proposal to provide financial incentives only to Medicaid patients is insufficient. She called for broader incentives across all payers and suggested increasing midwife reimbursement to drive practice change. Commissioner McDonald indicated openness to suggestions but did not commit to expanded programs. Sen. Comrie pressed on long-standing hospital bed shortages in Southeast Queens, noting a state study from 25 years ago documented underbedding that remains unresolved. When he asked why DOH opposed legislation to address the shortage, McDonald offered only to follow up in writing. Other notable issues: Sen. Hoylman-Sigal introduced legislation requiring insurance coverage for FDA-approved COVID-19 therapeutics like Paxlovid, which now costs over $1,500 on the commercial market. DFS Superintendent Harris confirmed the state expects only a 0.03 to 0.04 percent premium increase from eliminating insulin copays, citing studies showing overall cost savings from improved medication compliance. Assemblywoman Rajkumar highlighted that 40 percent of products from illegal cannabis smoke shops contain dangerous contaminants like E. coli and salmonella, and noted there are approximately 36,000 such shops operating statewide. The hearing underscored persistent disagreements between the Legislature and the Hochul administration over healthcare spending priorities, with lawmakers demanding more aggressive action on hospital closures, workforce shortages, and equity in maternal health outcomes. NEW YORK — Healthcare advocates and state legislators clashed sharply on Tuesday over whether the Governor's 2024-2025 budget adequately addresses a deepening financial crisis at hospitals and nursing homes, with testimony centering on Medicaid reimbursement disparities that advocates characterized as a civil rights issue. At a joint Senate-Assembly Finance Committee hearing, representatives from the Greater New York Hospital Association, Healthcare Association of New York State, and 1199 SEIU testified that the Executive Budget may cut hospital and nursing home funding by $1.3 billion despite claimed investments of $984 million. They argued that last year's 7.5 percent Medicaid rate increase for hospitals was effectively only 1.6 percent after accounting for cuts to the 340B drug program. George Gresham of 1199 SEIU delivered particularly pointed testimony, calling Medicaid reimbursement disparities "racism" and arguing that hospitals serving communities of color receive 30 percent less reimbursement than other facilities. "How can you deny the fact that the communities that primarily are being faced with these cuts are the Black and brown communities," Gresham said. "How can we stand up and say that that's okay?" Ken Raske of the Greater New York Hospital Association called the budget "built on a shaky foundation" and urged legislators to eliminate Medicaid payment disparities over four years, arguing the state has sufficient cash reserves to fund the initiative. Senators pressed administration officials on specific concerns. Sen. Gustavo Rivera questioned whether federal funds approved in July for distressed hospitals would flow before the school-based health centers managed care carveout expires January 31st. Chairwoman Liz Krueger requested a detailed briefing on how managed long-term care Medicaid contracts allocate payments across worker wages, managed care fees, and other components. Sen. Pam Helming drew parallels to rural healthcare crises in her district, noting the loss of primary care physicians and cuts to Federally Qualified Healthcare Centers. Assemblywoman Kimberly Jean-Pierre Hunter described a nursing home in Central New York with only two days' cash on hand and asked for specific cost-cutting measures beyond staffing that would save hospitals without cutting care quality. The hearing revealed deep skepticism among legislators about whether the budget's workforce development proposals and medical debt initiatives address the immediate financial crisis facing safety-net hospitals. The administration did not provide detailed financial analyses of several proposals' impacts on hospital revenues. NEW YORK STATE SENATE FINANCE COMMITTEE — Healthcare industry leaders and advocates testified before a joint legislative hearing on the 2024-2025 Executive Budget on January 23, delivering stark warnings about hospital closures, nursing home bed shortages, and inadequate Medicaid reimbursement rates that they said are pushing the state's healthcare system toward collapse. George Gresham, president of 1199 SEIU United Healthcare Workers East, delivered particularly pointed testimony, citing the Governor's acknowledgment of a $1.87 billion surplus being held for a "rainy day" while hospitals close. "I'm highly offended because I've never imagined any governor would see that healthcare deserves to be cut for a rainy day," Gresham said, referencing the closures of Beth Israel, Kings County, and Kingsbrook hospitals. He argued that healthcare is being funded at only 70 percent of actual costs, creating an unsustainable situation. Ken Raske of the Greater New York Hospital Association warned that safety-net hospitals are "hitting the wall" and urged legislators to address root causes rather than apply temporary fixes. He noted that unmet need is actually increasing in the Governor's budget while safety-net funding decreases relative to need. Bea Grause of the Healthcare Association of New York State reported that New York has lost 5,600 nursing home beds since 2019, with approximately 2,000 of those losses in the Rochester area alone. She testified that without investment in nursing home care and regulatory reform, the situation will worsen. She also highlighted the lack of capital funding in the budget, noting that healthcare is evolving and capital dollars are essential for decentralization of care. Senator Gustavo Rivera, chair of the Health Committee, expressed frustration with the state's pattern of allowing healthcare facilities to reach crisis before intervening. "The state unfortunately seems to operate the way that they do this is that they just let it happen," he said, calling for long-term commitments to stabilize healthcare rather than crisis management. Advocates for primary care testified that New York spends only 5-7 cents of every healthcare dollar on primary care despite evidence it has the best return on investment. David Sandman of the New York Health Foundation and Jordan Goldberg of the Primary Care Development Corporation both supported bills requiring payers to dedicate 12.5 percent of spending to primary care. Goldberg noted that 6.5 million New Yorkers live in areas without adequate primary care access, and that the percentage of physicians in primary care has declined from 70 percent to 30 percent over 50 years. Rose Duhan of the Community Health Care Association of New York State, representing 75 organizations serving 2.3 million New Yorkers, requested increased Medicaid rates for health centers, noting they have not received significant rate increases in over 20 years. She also requested permanent Medicaid telehealth payment parity, as health centers currently receive only one-third of in-person reimbursement rates for telehealth visits. Senator May raised concerns about the impact of cuts on regional economies, noting that healthcare represents 20 percent of the economy and is an anchor to every community. Senator Brouk described a crisis in Rochester where a hospital had over 100 patients ready for discharge but unable to leave due to nursing home bed shortages. The hearing highlighted a fundamental disagreement over healthcare funding strategy: industry and labor leaders argued for increased Medicaid reimbursement rates to stabilize the system, while legislators expressed frustration with the state's approach of allowing crises to develop before intervening. NEW YORK — Health care advocates and industry representatives clashed with state lawmakers Tuesday over the Governor's proposed 2024-2025 budget, with particular contention over $600 million in proposed cuts to health plans and quality incentive programs that serve millions of New Yorkers. The joint legislative hearing on the health budget revealed deep divisions over how to address New York's healthcare workforce crisis while managing state finances. Community health centers, health plans, and patient advocacy groups testified that proposed cuts would undermine efforts to expand primary care access and address health disparities, while a data analyst from the Empire Center argued the state should focus on spending smarter rather than spending more. The most contentious issue was the Governor's proposed Medicaid managed care procurement, which would require health plans to compete for contracts with a minimum of two plans per region. Mr. Eric Linzer, president of the New York Health Plan Association, warned this would eliminate plans and disrupt coverage for more than 5 million New Yorkers. "This year will effectively result in the elimination of health plans from the program, taking away options and disrupting provider relationships," Linzer testified. The Legislature rejected a similar proposal two years ago. Also controversial were proposed cuts totaling more than $400 million from eliminating a 1 percent administrative rate increase for Medicaid managed care plans, and the complete elimination of the Quality Incentive program, which totals more than $223 million. Ms. Erin Drinkwater of MetroPlusHealth testified that these quality funds support critical work addressing housing insecurity and health disparities. "Each year coming hat in hand for those dollars creates a lot of instability," she said. Testifiers from community health centers emphasized the severe shortage of primary care providers and called for adequate Medicaid reimbursement rates to attract and retain staff. Ms. Rose Duhan of the Community Health Care Association of New York State noted that even with expanded scope-of-practice changes, "when there's no providers, it doesn't matter what you pay them." Sen. Pam Helming raised pointed questions about gaps in the budget proposal, particularly noting that New York primary care physicians already pay 68 percent more in malpractice insurance than Pennsylvania, the second-highest state. She questioned whether the budget's proposed increases in malpractice costs would help or hinder recruitment of primary care doctors. The hearing also featured support for several Executive Budget proposals, including continuous Medicaid coverage for children ages zero to 6, elimination of cost-sharing for insulin, and expansion of coverage to low-income immigrants. Ms. Mia Wagner of Health Care for All New York cited a Rutgers-Columbia study showing that providing insurance to immigrants costs approximately $3,800 per person annually, compared to $9,428 for U.S.-born adults. Mr. Bill Hammond of the Empire Center provided a contrarian perspective, noting that New York spends 70 percent more per capita on Medicaid than the national average and has more healthcare workers per capita than any other state. He urged lawmakers to "spend smarter, not bigger," and raised concerns about distressed hospitals receiving hundreds of millions in annual subsidies without becoming financially viable. The hearing underscored the tension between addressing immediate healthcare access crises and managing state budget constraints, with lawmakers facing pressure to restore proposed cuts while finding efficiencies in a system already consuming substantial state resources. NEW YORK STATE SENATE FINANCE COMMITTEE — Long-term care providers, HIV advocates, and public health officials testified before the Joint Legislative Committee on Finance on January 23, 2024, expressing strong opposition to significant cuts in the Governor's 2024-2025 Executive Budget for health services. Jim Clyne, representing over 400 not-for-profit and government long-term-care providers through LeadingAge New York, delivered the most pointed testimony, stating the budget imposes a $633 million state share reduction in Medicaid for long-term-care services while the rest of the Medicaid budget faces only a $112 million cut. Clyne noted that nursing homes are reimbursed at 74 cents on the dollar for care, yet the budget includes no new dollars for staff despite state-mandated staffing requirements. He cited 11 nursing home closures in three years—nine of them not-for-profit—and reported 110 patients waiting for nursing home care in a single Rochester hospital. Adult day healthcare programs have declined from 115 statewide to just 55, with only one medical adult day program operating in the Bronx. Charles King, testifying on HIV services, commended the Governor's proposal for streamlined HIV testing in emergency rooms but urged expansion of rental assistance for people living with HIV outside New York City. He noted 2,500 households in that region are homeless or unstably housed, and that a bill on this issue has passed the Governor five years without housing a single household. King also highlighted that one in five New Yorkers diagnosed with HIV receive simultaneous AIDS diagnoses, a rate significantly higher for undocumented immigrants who lack health insurance and primary care access. Lindsay Heckler of the Center for Elder Law & Justice opposed the Governor's proposal to allow assisted living residences to avoid Department of Health inspections if accredited, arguing "accreditation must never be a substitute for oversight." She also opposed discontinuing the EQUAL program and called for increasing the personal needs allowance for nursing home residents from $50 to at least $150 monthly. Dr. Irina Gelman, representing all 58 local health departments in New York State, stated the budget would exacerbate workforce depletion in public health and create unfunded mandates. She noted that funds to fight rabies and tick-borne illnesses have been completely eliminated. Chairwoman Liz Krueger pressed witnesses on spending efficiency, asking where New York's high health expenditures go and whether administrative costs in home care are justified. Bill Hammond, a data analyst, noted New York spends as much on Medicaid home care as the other 49 states combined despite having only 6 percent of the U.S. population. Sen. Gustavo Rivera challenged Hammond's fiscal conservatism, citing St. Barnabas Health System in the Bronx—where 95 percent of patients are Medicaid—as an example of how underfunding institutions leads to greater costs when they fail. Rivera advocated for the New York Health Act as a fundamental solution. Clyne recommended a two-year phase-in to fill a $810 million gap in long-term care funding, seeking $510 million in the current year. He noted that nursing home rates have not been rebased since 2007, unlike most states which rebase every two to three years. New York's long-term care and children's health systems face a funding crisis, according to testimony at a joint Senate-Assembly hearing on the 2024-2025 health budget on Tuesday. Stephen Hanse, president of the New York State Health Facilities Association, told lawmakers that 478 of 610 nursing homes cannot comply with state staffing mandates due to severe labor shortages, with Medicaid reimbursement rates of $11.45 per hour covering only 74 percent of costs. He requested $510 million in state investment to address what he called 15 years of disinvestment in seniors relying on Medicaid. Meg Ryan, interim CEO of Nassau Health Care Corporation, testified that the public hospital system has lost $267.6 million in state funding since 2020 and submitted three VAPAP applications totaling $206 million in March 2023 with no funding decisions yet. She warned that without state funding restoration, the hospital cannot continue serving Nassau County's 260,000 annual patients, 90 percent of whom are on Medicare or Medicaid. Early Intervention advocates painted an equally dire picture. Scott Mesh of the Agencies for Children's Therapy Services said 2,000 therapists have left the field in recent years due to low reimbursement rates, with over 50 percent of children not receiving all needed services. Brigit Hurley of the Children's Agenda reported that 7,360 children were waiting for EI services as of August 2023—a 500 percent increase since 2020—and that the percentage of families receiving services on time dropped from 78.3 percent in 2014 to 53.9 percent in 2022. Nicole Bryl, CEO of Children's Health Home of Upstate New York, opposed the proposed $125 million in health home restructuring cuts, arguing they would end the program serving 12,000 children monthly across 55 upstate counties. Sen. Rhoads pressed Ryan on why NUMC's VAPAP applications filed nearly a year ago remain unfunded despite the Health Commissioner's statement that hospitals only need to apply. Sen. Brouk questioned whether the proposed 5 percent EI rate increase was sufficient, noting the long-term costs of failing to provide early intervention services. Mike Duteau of the Community Pharmacy Association opposed a proposed requirement for pharmacies to submit annual cost reports, calling it duplicative of existing federal NADAC pricing data collected from 60,000 pharmacies nationwide. He also called for OMIG audit reform, citing a case where a pharmacy faced a six-figure recoupment for a clerical error in entering an NPI number. The hearing underscored tensions between the Governor's proposed budget cuts and advocates' arguments that disinvestment in preventive care and early intervention will result in far costlier interventions down the line. NEW YORK — Healthcare advocates, medical professionals, and union representatives testified before the state Legislature on Tuesday about the 2024-2025 Executive Budget's health proposals, with witnesses highlighting critical workforce shortages, funding gaps, and service delivery disparities while praising some budget initiatives. Testimony centered on three major healthcare challenges: Early Intervention service gaps, nursing workforce retention, and primary care physician shortages. Ms. Hurley of The Children's Agenda presented data showing that children of color are referred to Early Intervention services at lower rates, wait longer for services, and are more likely to not receive them, citing an August 2021 Bureau of Early Intervention report. She praised the Executive Budget's proposed 4% rate modifier for underserved and rural areas as a step toward addressing racial and geographic disparities, though she emphasized that full funding of Early Intervention services is more cost-effective than later special education interventions. On nursing workforce issues, representatives from the New York State Nurses Association and CWA District 1 challenged the characterization of a "nursing shortage," presenting data showing active RN licenses increased 30% from 2018 to July 2023 (from 305,000 to 394,000), while the actual nursing workforce grew only 4%. Mr. Bell of NYSNA attributed the gap to poor working conditions, low pay, and understaffing rather than insufficient supply. Both unions noted that traveling nurses command two to three times the salary of permanent staff, yet hospitals continue to rely on them rather than improving conditions for permanent workers. Ms. Miller of CWA called for immediate cash infusion to stabilize the workforce and full Medicaid funding to close the 30% reimbursement gap. Dr. Jerome Cohen of the Medical Society of the State of New York opposed several budget proposals, including elimination of the Committee for Physicians' Health program and a proposed $40 million cost-sharing requirement for excess medical liability insurance on 15,000 physicians. He argued these measures would increase physician burnout and reduce patient access to care. The Associated Medical Schools of New York praised the Executive Budget's $3.6 million allocation for the Diversity in Medicine Program, now in its 33rd year and supporting 950+ students across 19 programs. Mr. Jonathan Teyan also advocated for restoring the $3.5 million Empire Clinical Research Investigator Program, which supports early-career physician scientists. Sen. Cooney focused on the Child Tax Credit expansion, asking about impacts on upstate families and how they utilize the benefits. Sen. Myrie raised concerns about potential impacts of the Supreme Court's affirmative action decision on diversity programs, while Chair Krueger questioned the economics of the traveling nurse market and asked about medical school initiatives to increase primary care physician production. The hearing, held January 23, reflected broader tensions in New York's healthcare system between workforce supply and working conditions, funding adequacy, and equitable service delivery across racial and geographic lines. NEW YORK STATE LEGISLATURE HEARS TESTIMONY ON HEALTH BUDGET CUTS TO NURSING, FOOD ASSISTANCE, AND REPRODUCTIVE CARE Albany — Advocates and healthcare workers testified before a joint legislative committee on January 23 that the state's 2024-2025 Executive Budget inadequately addresses critical shortages in nursing, food assistance, and reproductive healthcare access. Nursing representatives from the New York State Nurses Association and Communications Workers of America painted a dire picture of hospital staffing crises. The CWA reported filing 8,000 violations of the state's Clinical Staffing Committee law over just four to five months, representing what they characterized as a small fraction of actual daily violations. In some intensive care units, nurse-to-patient ratios have deteriorated to 1:5 instead of the required 1:2, according to testimony. Chairwoman Liz Krueger questioned whether the state could redirect the 2-2.5 times higher wages paid to traveling nurses toward permanent, unionized staff. NYSNA representatives also raised concerns about the Interstate Nurse Licensure Compact, arguing it would allow other states—including those with restrictive abortion laws—to regulate New York nurses and potentially expose providers to liability for reproductive healthcare services. On food insecurity, three organizations testified that the Executive Budget's proposed nearly 40% cut to the Hunger Prevention Nutrition Assistance Program (HPNAP) comes at the worst possible time. New York's Department of Health reported that nearly one in four adults experienced food insecurity in the past year, with the Bronx reaching 40% prevalence. Food banks are serving 62% more people than pre-pandemic levels, yet the budget proposes flat funding for the Nourish New York program and a $2 million cut to SNAP outreach. The Food Pantries for the Capital District reported their food access referral line received 85 calls in a single day—the highest in the organization's history. Some pantries have reduced service from twice monthly to once monthly due to resource constraints. Planned Parenthood Empire State Acts requested increased Medicaid reimbursement for medication abortion, which comprises 64% of their abortion care but is reimbursed at rates below those in California, Illinois, Vermont, and Oregon. The organization also sought $35 million in grant funding for abortion providers and passage of the Reproductive Freedom and Equity Program. The Hospice and Palliative Care Association of New York State testified that New York ranks last in the nation for hospice access and has received zero funding increases in the current and previous budgets. The organization opposed the use of state waivers to allow hospital expansion into home-based care without Certificate of Need review, arguing it circumvents public process and threatens community providers. Assemblymember Jessica González-Rojas questioned whether the safe staffing bill passed in 2021 or 2022 had achieved its intended impact, given continued reports of inadequate conditions. She also pressed for details on the Reproductive Freedom and Equity Program's importance in the post-Roe landscape. The hearing underscored tensions between the Executive Budget's proposed cuts and testimony from healthcare workers, food security advocates, and reproductive rights organizations about deepening crises in their respective sectors. NEW YORK — Home care providers, workers, and advocates delivered sharp criticism of Gov. Kathy Hochul's 2024-2025 budget proposal at a joint legislative hearing on health spending Tuesday, warning that proposed wage cuts and unspecified Medicaid reductions threaten to destabilize an already fragile system serving hundreds of thousands of New Yorkers. The most contentious proposal was the Governor's plan to cut wages for Consumer Directed Personal Assistance (CDPA) workers by $2.54 per hour—a 12 percent reduction—that would eliminate recent wage gains and make these workers "second-class home care workers," according to Bryan O'Malley of Consumer Directed Action of New York. Mr. O'Malley argued the cuts would trigger worker departures and leave vulnerable elderly and disabled residents without care, noting that even a minimal increase in pressure sores would cost the state far more than any savings achieved. Sen. José Rivera expressed deep skepticism about the Governor's proposal for $200 million in unspecified Medicaid cuts, calling it unprecedented and questioning whether the administration had conducted any stakeholder outreach. Panel members unanimously indicated they had received no communication from the administration about how these cuts would be implemented. Kathy Febraio, president of the New York State Association of Health Care Providers, reported that nearly 30 percent of licensed home care agencies operated at a loss in fiscal year 2021 and called for a 10 percent Medicaid rate increase. She included testimony from Karen Clark, executive director of Home-Health Care Partners, describing her agency's decision to close after nearly 30 years of operation, citing "grim" prospects for the industry. Connor Shaw of Home Healthcare Workers of America, representing 40,000 home care aides, detailed real-world impacts of the wage cuts: one agency will lose funding for an after-school tutoring program on February 15th that had increased worker retention from 35 percent to 71 percent in the first 180 days. He warned that aides earning $17.50 per hour cannot afford transportation to serve patients in outer boroughs without reimbursement support, effectively ending home care access in areas without public transit. Chris Vitale of the Empire State Association of Assisted Living reported that 700 adult care facility beds closed in the past year alone, with 3,100 beds lost over the past decade. He urged restoration of the $6.5 million EQUAL program and a 13.5 percent bridge rate increase for the Medicaid-funded Assisted Living Program, noting the current rate base is 30 years old. Mr. Cardillo of the Home Care Association noted that certified home health agencies serving over 500,000 New Yorkers annually are operating substantially below margin and urged inclusion of Assemblywoman Paulin's A7568 to address their needs. On food insecurity, testifiers advocated for direct contracts to food providers rather than reliance on food bank intermediaries, noting that organizations with direct contracts receive cheaper prices through wholesalers and farmers, allowing dollars to stretch further. Ms. Pender-Fox described a collaborative model in the Capital Region where five pantries with direct contracts expanded to serve approximately 32-33 pantries statewide, each ordering fresh, culturally appropriate foods tailored to community needs. The hearing, held before the Senate Finance Committee, revealed deep concerns about the budget's impact on a workforce already facing a 100,000-aide shortage in New York State and a growing elderly population with increasing care needs.