BILL NUMBER: S3131

SPONSOR: HELMING
 
TITLE OF BILL:

An act to amend the social services law, in relation to aligning Medi-
caid optional services with private sector health benefits

 
PURPOSE:

The purpose of this bill is to facilitate the smooth transition from
welfare dependency to self-sufficiency by requiring that adult Medicaid
optional services be consistent with private sector health insurance
coverage levels, as specified in Article 43 of the New York State Insur-
ance Law. The bill does not apply to those under the age of 21 or to
those receiving long-term care services.

 
SUMMARY OF PROVISIONS:

Section 1: Establishes title as Medicaid taxpayer equity act

Section 2: Legislative findings
              

Section 3: Amends title II of article 5 of the social services law,
adding a new section stipulating that the state shall not offer to indi-
viduals older than 21 Medicaid optional services that exceed the minimum
benefit required under article 43 of the insurance law

Section 4: Requires the commissioner of health to submit to the federal
department of health and human services for approval any amendments to
the state plan

Section 5: Effective date

 
JUSTIFICATION:

Under existing law, some of the Medicaid optional services exceed the
health insurance coverage levels required for group plans under Article
43 of the Insurance Law. As a result, those on Medicaid receive a higher
level of health coverage than most employees working in either the
private sector or the public sector.

There are several important reasons highlighting the need to make Medi-
caid benefit coverage consistent with the health insurance coverage
generally available to employees in New York State.

First, inconsistent Medicaid benefit levels trap people in welfare.
Under current law, welfare recipients are discouraged from getting a
private sector job because private insurance coverage is lower than
Medicaid coverage. By making Medicaid coverage comparable to private
sector coverage, welfare recipients will not lose health coverage when
they accept a private sector job. Ensuring that Medicaid benefit levels
are consistent with private health insurance coverage will facilitate
the smooth transition from welfare dependency to self-sufficiency.

Second, it is fundamentally unfair to require taxpayers to fund optional
Medicaid services that exceed their own insurance coverage.  Welfare
recipients should not have better health coverage than the taxpayers who
the bill.
Third, Medicaid coverage consumes a substantial amount of both State
taxes and local property taxes. Reducing the overall cost of this
program would provide tremendous benefits to both State and local
taxpayers.

Fourth, the high cost of Medicaid forces higher State and local taxes
that hurt the business competitiveness of New York State, It is abso-
lutely critical that New York State and local governments reduce their
tax burden on local businesses so that these businesses can afford to
grow and expand, add more jobs, and offer better wages and benefits to
employees. One of our top priorities should be to help New York State
become more competitive. The only way to accomplish that goal is to
bring State and local spending in line with the rest of the nation. One
of the largest categories of expense facing both the State and its coun-
ties is the cost of Medicaid.

 
LEGISLATIVE HISTORY:

2023-2024: S.1697 referred to Health

2021-2022: S.2275 referred to Health

2019-2020: S. 2502 referred to Health/A.5545 held in Health

2017-2018: S.5702 referred to Health/A.4508 held in Health

2015-2016: A.5120 referred to Health

2013-2014: A.4894 referred to Health

2012: A.9384 referred to Health

 
FISCAL IMPLICATIONS:

According to 2012-2013 data on Optical and Dental spending, this legis-
lation will save State and local governments 114 million dollars.

 
EFFECTIVE DATE:
120 days after it becomes law.