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Unified budget proposed by lawmakers plans Medicaid change: What is it?

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  • Staff Report 

This week, New York lawmakers repealed a transition from Medicaid managed care plans to NYRx, a fee-for-service Medicaid program, in their one-house budget resolutions. The transition was initially proposed in Gov. Kathy Hochul’s budget plan.

The Medicaid carve-out was first introduced in the state’s 2020 budget, but its implementation was delayed for two years. The delay is set to expire on April 1.

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Some legislators argued that repealing the Medicaid carve-out could prevent interruptions in healthcare services. Assembly Speaker Carl Heastie (D-Assembly District 83) emphasized the importance of maintaining hospitals’ abilities to provide care under the current system.

Pharmacy advocates, however, believe the transition would improve access for Medicaid recipients to New York State pharmacies. Heather Ferrarese, President of the Pharmacists Society of the State of New York, explained that the shift to NYRx would enable more pharmacies to join in-network, providing easier access to patients.

Local county leaders suggest that the transition could be beneficial for Medicaid patients, particularly in rural areas, and could impact the Division of Budget’s estimates for Medicaid costs. Steuben County Administrator Jack Wheeler stated that finding efficiencies in the Medicaid program without harming recipients is a positive move.

The one-house budget resolutions passed in the Senate and Assembly on Thursday. Lawmakers will now enter negotiations with the governor, with the final budget plan due on April 1.