Empire Justice Budget Memo: Preserve Immediate Needs Medicaid

Empire Justice March 04, 2015

Preserving Immediate Needs Medicaid is Critical to Avoiding Unnecessary Hospitalization and Institutionalization

Recommendation: Reject the Governor’s proposed elimination of immediate needs Medicaid to avoid unnecessary institutionalization and hospitalization due to lack of access to services (Health and Mental Hygiene Article VII Legislation, Part B, Sections 35 and 36).

The Executive Budget seeks to amend the Social Services law to block the temporary provision of medical services to Medicaid applicants whose medical conditions necessitate immediate care or treatment, and who cannot afford to pay for this treatment themselves.  Under the proposal, only people already determined eligible for Medicaid, or the few who qualify for presumptive Medicaid coverage, could obtain urgently needed medical services, including services like home care, that are the difference between remaining in the community and being confined to a nursing home, hospital or other institution.

This is particularly problematic because applying for Medicaid can be a very lengthy process for seniors and people with disabilities who cannot use the Marketplace, but instead must apply at their local department of social services.  In most cases, a Medicaid eligibility determination must be made within 45 days of application.  But that month and a half wait for medical services can mean the difference between a person obtaining medication to stabilize a life threatening condition and being hospitalized; it can mean the difference between an individual being discharged home from a hospital with personal care services and languishing in a hospital or a nursing home for months.  In our experience, many individuals wait even longer than 45 days to be approved for Medicaid so that they can access services. 

For individuals whose immediate need is to access home care services so that they may remain in the community, the application time period and application delays are compounded by the lengthy process for getting approved for home care and enrolled in a Managed Long Term Care plan even after a Medicaid eligibility determination.  This process frequently leaves people waiting months to receive home care services even after a Medicaid eligibility determination. 

Without the ability to access temporary immediate need Medicaid to get prescriptions filled, see a medical provider or obtain home care services, Medicaid applicants are at serious risk of deteriorating medical conditions, psychiatric decompensation and institutionalization.  Moreover, the elimination of immediate need Medicaid risks costing Medicaid more money in the long run since, as conditions worsen, expensive acute and nursing home care becomes more likely.

Prompt provision of assistance to poor Medicaid applicants with serious medical conditions fulfills New York’s worthy mandate to aid the needy in situations where their health or safety will be otherwise endangered.  It also furthers the State’s commitment under Olmstead to ensure the integration of people with disabilities in the community.

Given all these factors, we strongly urge the legislature to reject the proposed elimination of Immediate Needs Medicaid.