New York: 49 Proposed Strategies To Rein In Medicaid Budget 

New York Governor Andrew Cuomo created a panel in 2010 known as the Medicaid Redesign Team to identify cost-savings proposals for the state program.  The New York Times reports that after receiving input from stakeholders including about 3,000 suggestions, the panel identified 49 potential strategies with expected cost savings of $4 billion, a significant amount in a state that spends $54 billion on Medicaid annually.  However, advocates are concerned about proposed cuts to services that help disabled patients to remain in their homes by assisting with housekeeping, shopping, cooking, and other activities of daily living.  Valerie Bogart, an attorney with Selfhelp Community Services, called the elimination of these services a "penny-wise, pound-foolish," and explained that "Without assistance to shop, clean or do laundry, a frail individual is at much higher risk of falling or other hazard, triggering emergency acute medical care and potentially more extensive long-term care." For more information, read:

NY Medicaid Redesign Team "Description of Proposals"
New York Times: "49 Suggestions for Cutting Billions in State's Medicaid Costs"   

Increased Cost-Sharing Does Not Save Money And May Worsen Health Care 

A recent RWJF analysis of studies of increasing cost-sharing (increasing the patient's share of the cost of their health care) found that it often leads to worse health outcomes and does not always achieve cost savings.  The findings are especially relevant for state policymakers who may be considering increasing cost-sharing in Medicaid as a way to save money.  In one Rand study, higher cost-sharing led to less patient-initiated care for healthier patients, however, this population already has low medical expenses.  The Rand study also found that higher cost-sharing led to patients reducing their use of both appropriate and inappropriate care about equally.  For people with chronic conditions that need high amounts of health care, cost-sharing will not necessarily mean a reduction in the amount of care they consume because their treatments are medically necessary.  The authors explain that additional studies found that "that low-income people in poor health are more likely to suffer adverse health outcomes, such as increased rates of emergency department (ED) use, hospitalizations, admission to nursing homes, and death, when increased cost-sharing causes them to reduce their use of health care, particularly prescription drugs..."  Businessweek provides a short summary of eight states and their plans to reduce costs through cutting payments to providers, reducing benefits, and restricting eligibility requirements. For more information, visit:

Robert Wood Johnson Foundation: "Cost-sharing: Effects on Spending and Outcomes"
Businessweek "Taking a Scalpel to Medicaid" 

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California: New Report Analyzes Implications Of Budget Cuts On Most Vulnerable 

A recent study interviewed 33 Californians who are consumers of long-term care services to better understand how they rely on these programs.  All of the interviewees receive at least Medicare, Medi-Cal, and In-Home Supportive Services (IHSS).  The authors find that most of the recipients rely on a patchwork of services to receive the care they need and that all of the interviewees prefer to stay in their homes as compared to institutional care.  The authors note that Governor Brown's 2011-12 proposed budget will cut an additional 8.4% (on top of the 3.6% cut from last year) to the In-Home Supportive Services program that these interviewees rely on.  Brown's budget will also eliminate hours for domestic and related services for children and for the 48% of adults in IHSS who reside in a "shared living arrangement" with a relative, friend, or other person.  The Paraprofessional Healthcare Institute recently noted that these cuts to services could expose the State of California to legal liability based on the landmark Olmstead decision. For more information, visit:

UCLA Center for Health Policy Research: "Holding On: Older Californians with Disabilities Rely on Public Services to Remain Independent"
PHI: "Proposed Cuts to California IHSS Could Face Legal Challenges"  

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California: Paid Sick Days Legislation Introduced

State Assemblywoman Fiona Ma introduced the Healthy Workplaces, Health Families Act on February 14, 2011.  The legislation would require employers to provide employees with paid sick days at the rate of one hour per every 30 hours worked.  Employees would not be able to use the sick days until after they had been employed for 90 days. The sick days could be used if the employee is ill or if a close relative is ill and requires care.  Family caregivers who are employed often face predicaments of balancing their job while maintaining their own health and/or taking their loved ones to doctor's appointments and this situation is exacerbated when employers don't provide paid sick leave.  In a 2010 poll about similar federal legislation, 86% of respondents reported favoring legislation that would mandate seven paid sick days per year.  For more information, visit:

California Legislature: "AB 400, the Healthy Workplaces, Healthy Families Act"
Public Welfare Foundation: "Paid Sick Days: Attitudes and Experiences"
Paid Sick Days Website

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