Paterson Wants Medicaid for Not-As-Poor

More New Yorkers who are too poor for private insurance and not poor enough for Medicaid could get health coverage under Gov. David Paterson's budget proposal, despite the state's sprawling economic woes.

Despite leaving hospital and health providers reeling at suggested cuts and decreased Medicaid reimbursements, Paterson is also pushing two ways to expand coverage for adults.

The proposal would allow more 19- and 20-year-olds who don't live with their parents to enroll in Family Health Plus, the state health care plan. Dr. Richard Daines, the state commissioner of Health, said that change would cost the state about $5 million in the short term, but save much more by preventing illness later on.

"They tend to fall through the cracks," Daines said. "A lot of them don't have ordinary insurance coverage type jobs."

Right now single adults and childless couples -- which includes 19- and 20-year olds -- must be at 100 percent or less of the federal poverty level -- if they are living on their own to qualify for benefits. Paterson wants to increase that to 160 percent of the federal poverty level, regardless of whether they live at home.

An individual in the 48 contiguous states could make no more than $10,400 a year to meed federal poverty guidelines.

The governor's budget proposal would also seek a federal waiver to allow adults at 200 percent of the federal poverty level -- about $20,800 a year -- to be eligible for Family Health Plus -- up from 100 percent for singles and childless couples, and up from 150 percent for parents. That proposal would be contingent on getting more funds from the federal government.

"I think short term solutions are absolutely necessary while we're getting to the long term solution," said Sister Christine Wagner, executive director of St. Joseph's Neighborhood Center in Rochester. "I wouldn't say anything is just a drop in the bucket, or just a Band-Aid -- so anything like this is going to help hundreds of thousands of people."

Wagner dedicates her work to the low income people who fall into the gap between Medicaid coverage and private insurance. With a teetering economy and additional layoffs, the medical center has seen an increased demand in the fourth quarter -- handling 300 more appointments than they did in the third quarter.

With the need only growing, Wagner said even small expansions, like those Paterson is proposing, could help.

"It would reduce our patient load and also give us some more options to give people who are falling in that niche between affordability and eligibility," Wagner said. "I'm happy to hear it."

If Paterson's plan passes and federal funds come through, Wagner estimated that the medical center would check the files of at least 1,000 of their approximately 3,500 patients in anticipation they would be covered under the new eligibility standards.

Paterson proposed increasing Medicaid spending 1 percent to $45.4 billion -- lower than the $48.2 billion it's projected to grow to in 2009-2010 if no legislative action is taken. The cost savings are largely achieved through cuts in reimbursements to hospitals, nursing homes and home care providers.

Part of that will be changing the payment structure to better support outpatient, ambulatory care and to stop overpaying for unnecessary inpatient treatment. The proposal would also eliminate some grants for hospitals and medical education.