The FY 2020 Enacted Budget authorizes the State to implement an across the board (ATB) reduction to its State Share of Medicaid payments ($190.2 million State share). Pursuant to this authority, such payment reductions will apply for dates of service January 1, 2020 through March 31, 2020 (balance of the 2020 fiscal year) and each State Fiscal Year thereafter. All non-exempt Department of Health state funds (from State share) Medicaid payments will be uniformly reduced by 1%. For services subject to the 1% reduction, all fee-for service provider payments will receive a decrease to Medicaid checks and/or Electronic Funds Transfers for dates of services on or after January 1, 2020. Similarly, managed care payments to health plans will be reduced through a 1% reduction to premium rates effective January 1, 2020.
Medicaid payments that will be exempted from the uniform reduction include:
1. Payments based on federal law prohibitions include, but are not limited to, the following:
- Federally Qualified Health Center services;
- Indian Health Services and services provided to Native Americans;
- Supplemental Medical Insurance – Part A and Part B;
- State Contribution for Prescription Drug Benefit (aka Medicare Part D payments);
- Any local share cap payment required by the Federal Medical Assistance Percentage (FMAP) increase legislation;
- Required payments related to the School Supportive Health Services Program and Preschool Supportive Health Services Program;
- Services provided to American citizen repatriates;
- Payments pursuant to the mental hygiene law;
- Payments for services provided by Other State Agencies including Office of Children and Family Services, State Education Department, and the Department of Corrections and Community Supervision;
- Court orders and judgments; and
- Hospice Services.
2. Payments funded exclusively with federal and/or local funds include, but are not limited to, the following:
- Upper payment limit payments to non-state owned or operated governmental providers certified under Article 28 of the NYS Public Health Law;
- Certified public expenditure payments to the NYC Health and Hospital Corporation;
- Certain disproportionate share payments to non-state operated or owned governmental hospitals;
- Certain managed care payments pursuant to section 3-d of Part B of the Chapter 58 of the Laws of 2010; and
- Services provided to inmates of local correctional facilities.
3. Payments, where applying the reduction would result in a lower FMAP as determined by the Commissioner of Health and the Director of the Budget will also be exempt.
Any questions you have should be submitted to the following electronic mailbox:
Make sure you include your provider name and Medicaid number on the email so that questions may be reviewed by the program area. Individual e-mails will not be answered, however, the Department of Health will generate frequently asked questions and responses, so providers should review the Department’s website on a regular basis.
Kenneth R. Cerini, CPA, CFP, FABFA
Ken is the Managing Partner of Cerini & Associates, LLP and is the executive responsible for the administration of our not-for-profit and educational provider practice groups. In addition to his extensive audit experience, Ken has been directly involved in providing consulting services for nonprofits and educational facilities of all sizes throughout New York State in such areas as cost reporting, financial analysis, Medicaid compliance, government audit representation, rate maximization, board training, budgeting and forecasting, and more.