By Mike Alvaro
For the Times Union
For people with intellectual and developmental disabilities, independence is rarely one dramatic breakthrough. It is built from ordinary things most New Yorkers never think about, whether it is a hospital bed at home instead of in an institutional facility, a lift that lets a parent safely move an adult son, or the incontinence supplies, feeding supplies and bath safety equipment that make it possible to live in the community rather than an institution.
Durable medical equipment and supplies are not a line item. They are the infrastructure of an independent life. But the independence of people with intellectual and developmental disabilities depends on a supplier network that is disappearing.
New York has lost roughly a quarter of its durable medical equipment suppliers since 2013. In a growing number of counties, a family caring for a child with a developmental disability, or a residence supporting adults who depend on medical equipment and supplies, has fewer and fewer places to call. The result: longer waits for deliveries, equipment that goes unrepaired and people who end up in a hospital or nursing facility because the basic supplies that kept them at home stopped arriving.
Each year New York pays Medicaid managed-care plans hundreds of millions of dollars to cover medical equipment and supplies for their members, and it pays those plans in full. But the plans are under no obligation to pass that money along. By the time the funds reach the companies that deliver, fit and service the equipment, a large share has vanished.
Based on analysis of claims data conducted by the Northeast Medical Equipment Providers Association, claims are being paid at roughly 62 cents on the dollar. Some plans pay less than half the state’s Medicaid fee schedule for identical items, and some route suppliers through third-party administrators that take a cut on top.
The fix to this problem is awaiting action by Gov. Kathy Hochul, and it will cost the state nothing. Legislation (S.8838-A/A.10576) passed this year by both houses with bipartisan support would require Medicaid managed-care plans to pass through not less than 100% percent of the state’s Medicaid fee schedule to suppliers of durable medical equipment.
The legislation does not raise rates. It does not expand coverage. It ensures that money the state has determined is the proper price for medical equipment and supplies reaches the people who provide them, instead of being absorbed along the way.
Gov. Hochul vetoed an earlier version of this bill last December, citing cost. That concern deserves a straight answer: The state has already paid these plans. The only question is whether the plans keep the money or the equipment gets delivered. This bill asks the state to spend nothing more than it already has, and to get what it already paid for.
People with disabilities fought for decades to win the right to live in their own homes and communities. They should not lose that right to a reimbursement gap most New Yorkers never knew existed.
Mike Alvaro is executive director of the Cerebral Palsy Associations of New York State.—
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