Since the state's announcement to move to a fee-for-service model, there has been an ongoing clash in between safety net providers and pharmacists. Both groups are concerned about the state's vulnerable populations but disagree on how to serve them most efficiently. The legislators behind the repeal fear that the carve-out will interrupt the delivery of benefits, specifically at a time when the state will be executing eligibility redeterminations. Alternatively, advocates see it as an opportunity to simplify the Medicaid program.
Assembly Speaker Carl Heastie was among the legislators behind the repeal. He fears the carve-outs impact on entities that serve the states most vulnerable populations. Heastie is looking to protect 340b provisions that safety net providers rely on.
Pharmacists in support of the transition think that the move is long overdue. They believe the switch will improve the Medicaid program's transparency and help expand access for program beneficiaries by giving them more choice in who fills their prescriptions.
Aside from the repeal, a legal challenge opposing the carve-out also started recently. Shortly after the one-house budget resolution was passed, safety-net providers Evergreen Health and Heritage Health and Housing filed a lawsuit against the New York State Department of Health to halt the April 1st carve-out. According to the suit, the state's decision is discriminatory and violates the ACA.
In recent months, New York's decision to shift from a managed care model to a fee-for-service model has been a significant source of contention. While the carve-out is set to begin on April 1st, it now faces a repeal effort from the New York State Senate and a lawsuit from providers. It's not clear how the carve-out will be affected at this point, but given the repeal, lawsuit, and upcoming eligibility redeterminations, there are undoubtedly numerous issues for the state to work through.
