The Times Union
It's something that the SEIU 1199 health care union has long sought, say critics who point to the provision as one of several Faustian bargains Cuomo struck with the union and others in exchange for their support of the sweeping Medicaid redesign plan outlined in the proposed 2011-12 budget.
"There is a sense it's pretty loose and could be interpreted pretty broadly,'' said Joanne Cunningham, who heads the state Home Care Association, which could feel the squeeze imposed by an expanded living wage measure. Several downstate counties have living wage provisions that mandate salaries of up to $14 per hour.
Cunningham's organization represents mostly non-profit home care organization such as visiting nurse associations. The group was not invited to serve on the Medicaid Redesign Team, which devised the cost savers.
Her concerns were echoed Thursday as members of an Assembly-Senate conference committee ran down a laundry list of items they thought were wrong with the redesign plan. The plan relies heavily on bringing Medicaid recipients into managed care plans such as HMOs.
That's all well and good, they said, but they warned it will likely take longer than the governor envisions.
"There are big, big unresolved issues," Cunningham said.
Sen. Kemp Hannon, R-Garden City, said placing recipients of the state's vast array of Medicaid programs into managed care is a tall order, especially considering they haven't yet created an organization to oversee the process, as called for in the redesign. "That is like a donut hole that needs to be filled," he said.
"This leap to managed care is not about to happen overnight," added Assemblyman Richard Gottfried, D-Manhattan. "The notion that it's going to produce these savings in this fiscal year is highly unrealistic."
As an alternative, Sen. Catharine Young, R-Olean, suggested setting up targets or milestones for realizing savings. "I think we can get here but we just need to have an orderly approach," she said.
Cuomo's budget calls for $2.3 billion in savings to the state's approximately $53 million Medicaid system. Administration officials stressed that they realize overhauling Medicaid is an ongoing process and they noted that the redesign team will continue to meet after the budget is finalized.
Some of those savings may fall on the backs of ordinary people, noted Bill Ferris, legislative director for AARP, one of several groups upset about a plan to scale back the state Medicare drug subsidy for seniors known as EPIC.
Also facing opposition is a plan to limit non-economic damages in medical malpractice lawsuits to $250,000. The Assembly removed the limit from their version of the budget and the influential trial lawyers bar is vigorously opposed to the change.