The budget maintains the “spousal refusal” provision, which allows legally responsible relatives (spouses and parents) to refuse to financially support their spouse or child for purposes of determining Medicaid eligibility. The governor originally proposed eliminating “spousal refusal” in his budget; however, the legislature preserved the provision. Middle and low income families rely on spousal refusal to preserve their income to make ends meet. The cost for long term care can vary greatly depending on the level of care that is necessary. Without “spousal refusal,” many couples might be forced to divorce and go on welfare in order to secure appropriate care for their loved ones.
Family Health Plus “Wraparound”
The New York MS CAN applauded the Governor’s plan to provide support to individuals between 133% and 150% of the Federal Poverty Line as they transition from Family Health Plus to a Qualified Health Plan (QHP) purchased through the New York Health Insurance Exchange. The budget bridges the difference in premiums, co-insurance, deductibles and cost sharing between FHP and subsidized QHP coverage by providing a wraparound for those individuals who are enrolled in FHP as of December 31, 2013. The New York MS CAN supported the expansion of the wraparound to those who are between 133% and 150% of the FPL who apply for coverage in 2014 and beyond. This group of individuals will face the same financial difficulty in securing affordable health insurance as those who enrolled prior to January 1, 2014. The budget makes this wraparound available to Family Health Plus participants regardless of when they enroll in the program.
Medicaid Managed Care Ombudsman Program
The New York MS CAN supports the creation of the Medicaid Managed Care Ombudsman Program (MMCOP). This program will help managed care enrollees resolve disputes with managed care entities, monitor, document and investigate systemic problems such as inadequate accommodations for people with mobility impairments, offer information, guidance and support, and provide direct representation in grievances, fair hearings and appeals. With the roll out of mandatory long term care already underway, the Society supports implementing the program, and urges the Executive to fully fund and implement this important initiative.
Medicaid Recipients Local Pharmacies Option
Medicaid recipients now have the option of ordering specialty drugs, such as medications used to treat MS, from local pharmacies as opposed to mail-order pharmacies. The 2013 New York State budget states, “if the managed care provider has designated one or more pharmacies for filling prescriptions for a particular drug or drugs, then such prescriptions may be filled – at the participant’s option – at any other pharmacy in the network as long as the price of the medication is comparable to that of a mail order pharmacy designated by the managed care provider. A mail order pharmacy is one whose primary business is to receive prescriptions by mail, telefax, or through electronic submissions, and to dispense medication to patients through the use of the United States mail or other common or contract-carrier services, and provides any consultation with patients electronically rather than face-to-face.” People living with MS will now have more choices as to where they get their prescriptions filled and local pharmacies and economies will benefit as well.