Hochul should reject the Cuomo community care carve-out | Opinion

In her historic first State of the State address, Gov. Kathy Hochul rightly recognized that New York’s health care system is in crisis.

Hospitals are turning away patients due to a lack of beds and staff. The workers who are on the job are pulling double duty and burned out by the ongoing coronavirus pandemic. This precarious situation impacts the wellbeing of all New Yorkers, but it hits the most vulnerable the hardest — those who are low income, people of color, and/or geographically isolated who have long faced structural inequities that make it harder to receive quality care. Because of those barriers, they have also been disproportionately impacted by COVID-19.

If Hochul wants to make good on her pledge to fix New York’s strained health care system and protect our most vulnerable populations, we ask her to start by rejecting one of her predecessor’s cruelest reform proposals — a policy that, if enacted, will shutter safety-net facilities statewide, leaving some of the sickest New Yorkers with no care options at all.

Unless the governor and state lawmakers act, New York will change its Medicaid prescription drug benefit from a managed care program to a fee-for-service program next April. That may seem merely formulaic, but the results would be nothing short of devastating. Carving out pharmacy benefits from the Medicaid managed care program would gut community-based health care and other services for vulnerable New Yorkers at the worst possible time.

The Medicaid pharmacy drug carve-out was a pre-pandemic proposal advanced by disgraced former Gov. Andrew Cuomo’s administration. If enacted, the plan would devastate the 340B drug discount program, which allows designated safety net providers to purchase medications at a reduced price and use the savings to provide essential services like healthcare, in addition to housing aid and food assistance, for low-income individuals.

The world has changed since the state put this plan on the table. At a time when the governor and public health experts are trying to discourage people from going to emergency rooms and hospitals are overrun with COVID patients, we should be boosting community-based alternatives for routine primary and preventive care, not threatening their very existence.

Congress established the 340B program in 1992 to enhance and improve care for marginalized populations served by safety-net providers. Under the program, discounts on prescription drugs are provided directly by drug manufacturers as a condition of their participation in the Medicaid program. The savings and revenue this generates support care for the uninsured population and services not covered by Medicaid — all at no additional cost to the taxpayer.

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Currently, 100% of 340B savings remain in the state and are reinvested in patient care — as required by law. The state maintains that carving out the pharmacy benefit will generate significant savings. But based on how Medicaid is funded in New York, the state would be required to transfer to the federal government more than 70% of the funding derived by dismantling the safety net system, moving resources out of New York State and away from communities in need.

After advocates and experts raised objections about the devastating impact of Cuomo’s carve-out, the state wisely postponed its implementation until April 2023. But over the past year, the health care landscape has grown worse instead of better, and the threat remains dire for safety net providers. For community health centers that serve 2.3 million New Yorkers a year — 71% of whom are people of color and 89% are low-income – the impact of the carve out is very real. They can’t face another year of uncertainty, so we are asking the governor to resolve this situation now and not wait until 2023 to do so.

A survey by the Community Health Care Association of New York State found that the communities served by safety-net clinics would lose access to at least $100 million in services annually if the carve-out is implemented. At least 32 community clinics would be forced to close entirely, and 79% of health centers said they would dismiss or lay off staff — a significant setback as the state works to recover from the pandemic’s economic impact.

New Yorkers are hurting. They are looking to the new administration for answers and support. Slashing jobs, reducing access to much-needed health care, and shuttering community health centers, Ryan White clinics, food pantries, and other programs and facilities that are keeping individuals alive is a terrible idea in a stable environment, and an impending disaster now.

Now is the time to make a clean break and retire the Cuomo carve-out plan once and for all. The neediest New Yorkers deserve nothing less.

Peter A. Grisafi is president and CEO of the Damian Family Care Centers Inc., a not-for-profit primary medical health center and dental care services provider, with locations in New York City, Long Island and the Hudson Valley.

This article originally appeared on Rockland/Westchester Journal News: NYS Budget: Kathy Hochul reject the Cuomo community care carve-out