1. “Medicaid in 2008 and Beyond: Challenges and Prospects”
New York State Budget and Policy Outlook
“Medicaid in 2008 and Beyond: Challenges and Prospects”
July 10, 2008
by Joseph Baker,
First Assistant Secretary for Health and Human Services

2. Current Budget 2008-09 Declining Revenue Projections
Over $1.7 billion in downward revenue revisions
$42.3B
$42.0B
$41.5B

3. Spends Less than the Exec. Budget for First Time in a Decade
State Operating Funds Spending (Billions)
$81.6 B
$80.9 B
$80.5 B
From 21-day amendment process, $800 million cut proposed by Governor Paterson, Legislature added $400 million back. Additionally, during close-out, we saw decreased spending in , which lowered our base, which lowered spending in by $700 million. Net $1.1 billion decrease. After $361 million labor settlement, we are roughly $700 million below Exec. Budget.

4. Major Policy Initiatives
K-12 Education: $1.8 billion school aid increase.
Economic Development: $1.6 billion statewide economic development capital plan ($700 million Upstate Revitalization Fund).
Health Care: Provides access to coverage for all New York’s 400,000 uninsured children; begins reforming reimbursement system to invest in primary and preventative care.
Higher Education: Nearly $2.5 billion capital investment in SUNY and CUNY projects; authorizes creation of Endowment, but does not specify funding source.
The $1.75 billion (8.9 percent) increase in K-12 education funding included in the Enacted Budget will bring total school aid statewide to $21.4 billion. The Enacted Budget provides $8.33 billion in school aid to New York City, an increase of $644 million or 8.4 percent.
Overall $1.6 billion statewide economic development capital plan. Included in that total is a $700 million Upstate Revitalization Fund to help get that struggling region moving again.
Last year, state budget expanded New York’s SCHIP program Child Health Plus so that nearly all 400,000 uninsured children would be covered. Bush Administration blocked the expansion. State will takeover the federal share of the program’s funding to ensure that expansion can go forward. We are also taking the first steps toward reforming New York’s outdated reimbursement system to invest in more effective primary and preventative care, rather than expensive inpatient care.
Nearly $2.5 billion capital investment in SUNY and CUNY projects; Authorizes creation of Endowment, but does not specify funding source. Originally proposed to monetize the Lottery. We’ll continue to evaluate that proposal (Rothschild RFP)

5. Expanding Access to Coverage
CHPlus expands to 400% FPL
Kids aging out of foster care in Medicaid until 21
Family Health Plus Buy-in
Family Health Plus Premium Assistance Program
Medical Needy levels will increase
Streamlining enrollment and renewal procedures
Enhanced outreach to uninsured NYers
Establishment of State Enrollment Center
Initiating Partnership for Coverage
The $1.75 billion (8.9 percent) increase in K-12 education funding included in the Enacted Budget will bring total school aid statewide to $21.4 billion. The Enacted Budget provides $8.33 billion in school aid to New York City, an increase of $644 million or 8.4 percent.
Overall $1.6 billion statewide economic development capital plan. Included in that total is a $700 million Upstate Revitalization Fund to help get that struggling region moving again.
Last year, state budget expanded New York’s SCHIP program Child Health Plus so that nearly all 400,000 uninsured children would be covered. Bush Administration blocked the expansion. State will takeover the federal share of the program’s funding to ensure that expansion can go forward. We are also taking the first steps toward reforming New York’s outdated reimbursement system to invest in more effective primary and preventative care, rather than expensive inpatient care.
Nearly $2.5 billion capital investment in SUNY and CUNY projects; Authorizes creation of Endowment, but does not specify funding source. Originally proposed to monetize the Lottery. We’ll continue to evaluate that proposal (Rothschild RFP)

6. Partnership for Coverage
Seven public hearings across the State in 2007.
Testimony from more than 280 people and groups.
Meetings with more than 60 stakeholder groups.
Modeling guidelines for proposals out for public comment June 30 through July 21.
Proposals include:
Single Payer “Medicare-for All”
New York Health Plus
Combined Public-Private Reforms
The Freedom Plan
Report expected at end of 2008.
The $1.75 billion (8.9 percent) increase in K-12 education funding included in the Enacted Budget will bring total school aid statewide to $21.4 billion. The Enacted Budget provides $8.33 billion in school aid to New York City, an increase of $644 million or 8.4 percent.
Overall $1.6 billion statewide economic development capital plan. Included in that total is a $700 million Upstate Revitalization Fund to help get that struggling region moving again.
Last year, state budget expanded New York’s SCHIP program Child Health Plus so that nearly all 400,000 uninsured children would be covered. Bush Administration blocked the expansion. State will takeover the federal share of the program’s funding to ensure that expansion can go forward. We are also taking the first steps toward reforming New York’s outdated reimbursement system to invest in more effective primary and preventative care, rather than expensive inpatient care.
Nearly $2.5 billion capital investment in SUNY and CUNY projects; Authorizes creation of Endowment, but does not specify funding source. Originally proposed to monetize the Lottery. We’ll continue to evaluate that proposal (Rothschild RFP)

7. Budget Forecast Spending Outpacing Revenues
10.2%
8.7%
Budget Gap
Budget Gap
2.7%
4.6%
The reason we have these gaps is that our base spending growth is far outpacing our base revenue growth. In , this is particularly dramatic:
Spending Growth: 10.2%
Revenue Growth: 2.7 %
Spending Growth: 8.7%
Revenue Growth: 4.6%

8. Significant Out-year Budget Gaps
Projected Out-year General Fund Deficits
$8.8B
$7.7B
$5.0B
$21.5 billion deficit over the next three years if we take no action. Significant challenges ahead.