© 2022 WSHU
NPR News & Classical Music
Play Live Radio
Next Up:
Available On Air Stations
Long Island News

New York Medicaid Redesign Programs Set To End As Federal Government Denies Extension

Rogelio V. Solis

Doctors across New York will test a new model of medical care that has shown some promising signs. But a Trump administration decision means they will lose their federal support at the end of this month.

Medicaid traditionally funds health care in what’s called a “fee-for-service” model. Doctors tell the federal government what procedures they did and what medicines they used, and the government reimburses them. The criticism is this prioritizes quantity of care over quality of care.

Some health care groups in New York have been working on a redesign of that system.

Doctor Bill Valenti explains:

“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 says fee-for-service doesn’t account for everything that happens outside a medical clinic.

“Housing, food, all those kinds of things are health care.”

But Medicaid doesn’t reimburse doctors for the time spent checking on a patient’s housing situation. It doesn’t reimburse public transit systems for hiring people to make sure older adults can navigate the bus routes to get to their doctor’s appointments…

Unless your state gets a waiver. And New York did. The federal government has been funding a pilot program to test this sort of wraparound approach to medical care.

But earlier this year, the federal government denied the state’s application for an extension. Funding is set to run out at the end of this month for dozens of programs across the state.