 Medicaid is a state/federal program providing health insurance coverage for people with low-incomes. Some people think it is money for hospitals. NOT  Medicaid has been described as a “river that flows through our communities” and supports many critical programs.

Others have described Medicaid as a lifeline!

 Stephen Berger, Hospital Closing Commission recommendations – BERGER 1: › 1 “Reimbursement reform should strengthen the long-term viability of institutions that disproportionately serve vulnerable populations including the uninsured and low income patients.” – NOT DONE! “Reimbursement reform should encourage the provision of preventive, primary and other baseline services and discourage the medical arms race for duplicative provision of high-end services.” – NOT DONE! “Expand the availability of home and community-based alternatives to nursing home placement and educate physicians, paraprofessionals, and consumers about these alternatives.” – NOT DONE! “Ensuring that all New Yorkers have a primary care home.” - NOT DONE “Ensuring adequate financial support to the primary care health care safety net.” – NOT DONE!

 When looking for our votes before the election, the Governor released an Urban Agenda with lots of good recommendations. He raised concerns about “uninsured New Yorkers are in working families and a large percentage of them live in the underserved communities that are the focus of Andrew Cuomo’s Urban Agenda.” “New York State needs to embrace a comprehensive approach to expanding access to care, including expanding the number of providers of primary care and number of providers of primary care and ensuring the true ‘safety net’ institutions ensuring the true ‘safety net’ institutions remain available to underserved communities.” remain available to underserved communities.” NOT

The now-Governor went on in this agenda to make clear recommendations for: expand access to primary care coverage; invest in multiple types of primary care centers; community health centers; school-based health centers; strengthen safety net institutions; adopt an explicit safety net institution strategy; address the epidemic of obesity and diabetes. NOT

 Instead the Governor appointed a 27 member Medicaid Redesign Team to make recommendations on how to cut $2.85 billion in state Medicaid dollars – so with federal matching it is almost a $6 billion cut.  This team does not represent New York residents. There is only one community representative. Only four members are people of color – and two of them work for the Governor.

 The recommendations from this “Team” were dropped into a place holder in the Governor’s Executive budget.  The people in charge have no concept of cultural competence and language competence. Strong advocacy resulted in a Task Force to examine and make recommendations about how to address health disparities.

 Nine task forces were set up – one was the Health System Redesign: Brooklyn Work Group, which was to report directly to the State Commissioner of Health.  Five members were appointed with no connection to North or Central Brooklyn. The Chair of the committee: Stephen Berger, so this became Berger 2.

o Close 1,200 hospital beds o Merge Wyckoff and Interfaith with The Brooklyn Hospital Center o Merge Brookdale with Kingsbrook Jewish o Move SUNY Downstate Hospital to Long Island College Hospital o Close Kingsboro State Psychiatric Hospital beds with patients going to Staten Island.

The Save Our Safety Net – Campaign (SOS-C) did an analysis of Berger 2, and found many problems. o No funding was made available to expand primary care services. Services were being removed from already medically underserved communities. o At this time, there is a great deal of concern that merging Interfaith Medical Center with the Brooklyn Hospital Center will mean a closing or reduction of services in Bedford-Stuyvesant, in the heart of Central Brooklyn.

o The hospital beds were counted wrong in several places. Instead of counting the beds in use, Berger counted the licensed beds – not the way it is supposed to be done. o Pairing Brookdale, a larger hospital with more services, with Kingsbrook Jewish was inappropriate. o Wyckoff decided not to work with Brooklyn Hospital. o Kingsboro was ‘saved’ o Instead of Downstate Hospital moving to Long Island College Hospital (LICH), the State University Board (SUNY) voted to close LICH.

 Although there were promises of State dollars from HEAL to implement the Berger 2 recommendations, almost no money has been released to Brooklyn, BUT- much of the available dollars have been spent in other parts of the State.  The Berger 2 recommendation to set up a Brooklyn Health Improvement Board has not happened.

 Pass state legislation that defines the health care safety net and direct funding to those providers.  Direct the $1 billion plus charity care dollars (federal DSH) to health care providers caring for the uninsured and are high Medicaid providers.  Change the way that the state does cut-backs in Medicaid reimbursement – 2% across the board cuts hurt safety net providers and are unfair.  Involve communities in planning and system design.  Do a “real” community health needs assessment.

There have been many recommendations – largely ignored – that would save money. Maybe not the ridiculous sum the Governor is asking for -- $2.85 billion. Some of the ways are:  Limit the amount of pay and benefits to $1 million for executives when figuring out how much Medicaid will pay for services.  Expand primary care services in all underserved communities with comprehensive services at hours and times that are convenient for people. This is the way to keep people out of Emergency Rooms and hospitals beds – both of which are more costly.

 Ensure that health are services are culturally competent and language competent. If communication between the person and provider don’t work, it often results in problems that are more costly to treat.  Provide special coordinated care services for people with chronic conditions, behavioral health issues, and those who need more specialized services. Other states have developed these kinds of programs and have helped people to use services and to benefit.  There are other programs that could work – but the people in charge have to be interested in helping people, keeping them healthy, and supporting access to needed services.

 First please holler loudly with me so they can hear us – FIRST DO NO HARM! (¡LO PRIMERO ES NO PERJUDICAR LOS PACIENTES!)  Second – GET INVOLVED AND FOCUS ON COMMUNITY HEALTH NEEDS.

 Third – join the Save Our Safety Net – Campaign and work with us to change what is happening.