1. February 1, 2012 Jason Helgerson, Medicaid Director John Ulberg, Medicaid CFO

2.  Includes 25 MRT Phase II recommendations. ◦ Remaining workgroup recommendations will be included in MRT waiver process.  No traditional cost containment items.  Budget is “cap neutral”  Provides two year appropriation and extends super powers.  Preserves 4% annual spending growth.  Proposes State takeover of local administration and county fiscal relief. 2

3. 3 Annual % Growth -Medicaid (4.0%) -School Aid (4.0% - school year basis) -State Ops/Fringe Benefits (-0.4%) -Debt (4.7%) -All Other Local Assistance (2.7%)

4. 2011-122012-132013-14 State Funds$21.1$21.8$22.8 -- DOH (Global Cap / 4% growth)15.315.916.6 -- Other State Agencies5.85.96.2 Federal Funds$24.5$24.2$26.1 Local Funds$8.6$8.0$8.5 All Funds$54.2$54.0$57.4 (dollars in billions) 4

5. Key Reforms

6.  Program Streamlining & State/Local Responsibilities  Managed Long Term Care Implementation and Waiver Redesign  Behavioral Health Reform  Health Disparities  Health Systems Redesign: Brooklyn  Basic Benefit Review  Workforce Flexibility and Change of Scope of Practice  Payment Reform and Quality Measurement  Affordable Housing  Medical Malpractice Reform 6

7. Workgroup 2012-13 Gross 2012-13 State 2013-14 Gross 2013-14 State Basic Benefit Review$-30.3$-15.2$-35.7$-17.9 Health Disparities$32.4$6.1$20.7$0.3 Payment Reform$100.0$50.0$100.0$50.0 Program Streamlining$25.0$4.5$40.0$8.0 Workforce Flexibility/Managed LTC$1.5$1.0$1.5$1.0 Spousal Refusal$-68.6$-34.3$-137.0$-68.5 Redirect Transition II Funds$-25.0$-12.5$-25.0$-12.5 Net MRT Phase II Recommendations$35.0$-0.4$-35.5$-39.6 (“-” denotes savings; dollars in millions)  Affordable Housing ($75 million in base) and Health Systems Redesign/Brooklyn (fiscal impact reflected in Payment Reform).  Net savings from phasing out growth in local Medicaid spending over three years is not included above. 7

8.  Expanding coverage of podiatry services for adult diabetics.  Providing breastfeeding support and tobacco cessation counseling.  Reducing payments for elective cesarean sections without medical indication.  Eliminating coverage for knee arthroscopy, back pain treatments, angioplasty, and growth hormones where there is no evidence of benefit. 8

9.  Expanding services to promote maternal and child health, hepatitis C care and treatment, harm reduction counseling and services, and language accessible prescriptions.  Providing reimbursement for interpretation services for patients with limited English and communication services for patients who are deaf and hard of hearing.  Implementing and expanding data collection to measure disparities. 9

10.  Essential Community Provider Network ◦ Provides short term funding to address facility closure, merger, integration or reconfiguration of services.  Vital Access Providers (VAP) ◦ Provides ongoing rate enhancements or other support during significant restructuring.  HEAL reserves of up to $450 million to ensure smooth transition of services within communities and to provide reinvestment capital. 10

11.  Establishes Exchange as public benefits corporation.  Nine member governing board.  Five regional advisory committees.  Thirteen policy studies. 11

12. TBD Requires State Legislation Application deadline: June 29, 2012 Establishment Level Two Applied December 30, 2011 to continue the planning process, consumer assistance activities, conduct policy studies and support Exchange IT ($48.5M) Establishment Level One (Dec) Awarded to the NYS Department of Health to continue the planning process and conduct policy studies ($10.7M) Establishment Level One (June) NY selected as one of 7 states to build information systems to operate the Health Insurance Exchange ($27.4M) Early Innovator Grant Awarded to NYS Insurance Department to begin the planning process ($1M) Planning Grant 12

13.  With Planning and Establishment Grant Funding and Technical Assistance from the Robert Wood Johnson Foundation, New York has a series of Exchange activities underway: ◦ Simulation Modeling ◦ Business Operations Work Plan ◦ Five-Year Exchange Budget and Self-Sustainability Analysis ◦ Exchange Policy Studies 13

14. 14 Why is it the right time for the State to take over responsibility for county Medicaid program growth and administration? 1. Current 3% local Medicaid growth cap exceeds 2% Property Tax Cap. 2. MRT and Federal health care reforms require greater administrative centralization to achieve efficiency and effectiveness goals.

15. 15

16. 16 Fiscal YearRest of StateNew York CityTotal 2012-13$0.0 2013-14$18.1$43.1$61.1 2014-15$55.3$131.8$187.0 2015-16$109.2$260.4$369.6 2016-17$163.2$389.0$552.2 2017-18$217.1$517.7$734.8 2018-19$271.1$646.3$917.4 2019-20$325.0$774.9$1,100.0 2020-21$379.0$903.6$1,282.5 2021-22$432.9$1,032.2$1,465.1 *Monroe County provides tax intercepts in lieu of Medicaid Cap payments. Monroe historical cap payments are included for comparative purposes as a proxy for estimating local relief under this proposal. Phase Down Growth Starting in 2013, Effective April 1, 2013 (in millions)

17. 17  Federal Health Care Reform requires single point of entry.  Enables fundamental rethinking/retooling of how Medicaid program is managed.  Results: Services delivered more uniformly, efficiently, and cost effectively.  State savings from capping administrative reimbursement at FY 2012 levels partially offsets State costs of takeover.

18. 18 ($ in millions) State Share2012-132013-142014-152015-16 Cap Medicaid Admin at 2011-12 levels($23.0)($46.9)($71.7)($97.5) Expansion of Enrollment Center$14.5$29.0$36.0 State Staff$5.0$9.0$11.0 FTEs1203706001,200 Subtotal – Medicaid Admin Takeover($3.5)($8.9)($24.7)($50.5) Limiting MA Cap Growth (Phase Down)--$61.1$187.0$369.6 Total – Financial Plan Impact($3.5)$52.2$162.3$319.1 Additional Admin Savings (Efficiency)($5.0)($21.5)($71.0)($130.5)

19. Work Ahead

20.  New York is poised to fundamentally transform its Medicaid program into a national model for cost-effective health care delivery.  New York is also well positioned to ensure that Medicaid reform also means more comprehensive health system reform.  The Medicaid Redesign Team has developed a multi-year action plan that if fully implemented will not only bend the state’s Medicaid cost curve but also improve health outcomes for more than 5 million New Yorkers.  To fully implement the MRT action plan, a ground-breaking new Medicaid 1115 waiver will probably be necessary.  Still a lot of work to be done: It is up to the state, stakeholders and the broader New York community to continue to work together to successfully implement this multi-year action plan. 20

21.  MRT Website: http://www.health.ny.gov/health_care/medicaid/redesign/  Sign up for email updates: http://www.health.ny.gov/health_care/medicaid/redesign/l istserv.htm  ‘Like’ the MRT on Facebook: http://www.facebook.com/NewYorkMRT  Follow the MRT on Twitter: @NewYorkMRT 21

22.  If you have questions from today’s presentation, please join us on Twitter, Friday, February 3, 8:30 – 9:30 AM for an opportunity to ask questions and have them answered in real time.  How to participate in the live Twitter chat: ◦ If you’re not already on Twitter, join at www.twitter.com ◦ Follow the MRT on Twitter: @NewYorkMRT ◦ Login to Twitter between 8:30 and 9:30 AM on Friday ◦ Ask questions by including #NYMRT in your tweets, or ◦ Directly tweet us by including @NewYorkMRT in your tweet ◦ You don’t have to tweet – you can watch the conversation just by following @NewYorkMRT on Twitter – updates will show up in your news feed. 22