INDEPENDENT LIVING: Some hospitals are not getting their fair share

Sarah K. Lanzo, Independent Living

November 29, 2019


Can anybody say that the cost of health care has decreased anytime in the last several decades? If it has, I'm not aware.

Medicaid has been vital to those with limited means, and measures have been enacted that can help, such as the Affordable Care Act (also known as Obamacare) which reduced the number of uninsured New Yorkers by half, but there are still 1.1 million who have no health insurance. Of concern is talk out of Albany that has identified a Medicaid crisis of over $4 billion, prompting the state to examine very closely all the areas wherein this overspend can be reduced if not eliminated.

Already in place, since 2011, for the hospitals that serve the uninsured and Medicaid users, the Department of Health's Disproportionate Share Hospital program set up a mix of federal and state funds into the Indigent Care Pool, so money would be available where it is most desperately needed.

But a funny thing has happened on the way to serving the patients. Politics has ruled the day, the state has moved very slowly in accomplishing the distribution of money and, after eight years, the ICP is far from achieving its purpose. Insufficient funds have reached public and private hospitals that are properly caring for their community and serving people without health insurance and the dramatically increasing numbers of Medicaid patients. There are also critical access and sole community hospitals around the state that need this funding to keep their doors open.

However, there are hospitals, many that are Academic Medical Centers or part of the network around those hospitals, that actually are making a profit rather than losing money. Yet these hospitals are still getting ICP funds, even if they don't serve the uninsured or have that many Medicaid patients. The prospect continues of overall reductions in DSH funds, and Governor Andrew Cuomo has been suggesting the state may have to decrease Medicaid funding not only for the hospitals, but for many of the in-home programs that save hundreds of millions of dollars each year in Medicaid.

For many years, patient advocates, some unions and elected officials have fought to change this inequity in funding, and bills A.6677-A/S.5546 are currently in committees in the Assembly and state Senate, respectively. They would "amend the public health law, in relation to the general hospital Indigent Care Pool, hospital reimbursements and adjustments to medical assistance rates to enhanced safety net hospitals; and ... amend … other laws relating to rates for residential health care facilities, in relation to extending the effectiveness of such rates." There is an important change in the formula for ICP designed to achieve equity in hospital funding.

Patient advocacy organizations such as the Commission on the Public’s Health System in New York City point out that this legislation must pass this year, as the existing ICP law sunsets in early 2020. But, like all things political, it doesn't happen just because it's the right thing to do!

As I have written before, it is you, the voter, that can have a crucial voice in this discussion. That is, if you believe that Medicaid dollars should be used to strengthen our communities by making sure they enable people to stay in their homes, assist them in taking charge of their own lives regardless of their disability, and have a right to work and pay taxes like the rest of us.

You, and any friends you can count on, are urged to contact the governor and your state legislators to inform them of your opinion of this critical issue that speaks to the need for equity in hospital funding for those with limited resources, and that possibly could empower them to turn their lives around and become contributing, working Americans.

Then you'll know that you did something good that day!


Sarah K. Lanzo is the director of Independent Living of Niagara County, a member of the Western New York Independent Living Inc. family of agencies that serve individuals with disabilities. For more information, call 284-4131, extension 200.