Feds End Pilot Programs In New York Testing A Redesigned Medicaid

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ROCHESTER, NY (WXXI) – The Trump administration has decided to cut federal support for local programs that have been testing a new model of funding medical care.

The programs, which exist across the state and are overseen locally by the Finger Lakes Performing Provider System, have been working on a shift from the traditional fee-for-service model to a value-based model.

In the fee-for-service model, which underlies Medicaid, health care providers tell the federal government what procedures they did and what medicines they used, and the government reimburses them.

Critics say this prioritizes quantity of care over quality of care.

Dr. Bill Valenti is the Chief of Innovation at Trillium Health in Rochester, which receives funding to test alternatives to the fee-for-service arrangement. He has been working on approaches to health care that he said are designed to keep people out of the emergency room.

“Hospitals are great, but the idea behind Medicaid redesign is to take a more preventive approach to care that keeps people on the outside of the hospital, because hospital care costs a lot of money,” Valenti said.

Focusing Medicaid reimbursements only on what happens in medical clinics fails to account for elements of a person’s life, like housing, food and transportation, that affect their health but are not reimbursed by Medicaid, he said.

“It’s more than writing a prescription,” Valenti said. “But you need staff and thought and time to build the system.”

The waiver that allows New York state to experiment outside the normal Medicaid system is set to expire at the end of this month. Earlier this year, the federal government denied an application to extend it.

Gov. Andrew Cuomo, a Democrat, said the Trump administration was playing politics with health care.

The federal Centers for Medicare and Medicaid Services, which administers New York’s waiver, said the decision was not politically motivated, but instead simply reflected the original agreement between the state and federal governments that the program would end on March 31.

The federal government said it would continue to “provide technical assistance” to the state after the program’s expiration.

Carol Tegas, the director of the Finger Lakes Performing Provider System, said under the waiver, federal funding has been going to transit services and food pantries and addiction treatment centers, all with the aim of keeping people out of the emergency room.

“That’s an opportunity lost now, under this denial. There’s no question about that,” Tegas said.

Cuomo said FLPPS will lose close to $63 million in federal funding as the state’s waiver expires.

Tegas said the group will not cease to exist when its funding lapses, but she worries the progress they’ve made will start to evaporate.

“Things aren’t going to change. Health care’s still going to be expensive. Outcomes aren’t going to be improving.” Tegas said. “We had an incredible opportunity.”

Tegas said she and other health care leaders will be lobbying the federal government to change its decision and renew New York’s waiver.