Cuomo unveils health care proposals

ALBANY - Tucked into Gov. Andrew M. Cuomo's Medicaid budget is a living wage requirement for home care workers the industry said will cost $400 million, one of dozens of proposals unveiled Thursday in a sweeping overhaul of the state's health care system.

Cuomo's plan closely follows the recommendations of a state panel he appointed, calling for nearly all 4.9 million New Yorkers on Medicaid to enter managed care, slicing payments to health institutions, and capping malpractice lawsuit awards at $250,000.

Overall, the $52.8-billion Medicaid budget - of which the state share is $15.1 billion - would be reduced by nearly $1 billion. The bill would limit Medicaid spending growth to no more than 4 percent a year. It would require hospitals to make savings when the cap is reached.

"New York State has been living beyond its means for far too long," Nirav Shah, the state health commissioner, said in legislative testimony Thursday. "Our spending is the highest in the nation, and we aren't getting the value we should demand."

The plan must be approved by the legislature, and battle lines were shaping up Thursday. Hospitals and unions supported the plan while the home care industry, attorneys and advocates for the poor and disabled opposed parts of it.

Sen. John DeFrancisco (R-Syracuse), chairman of the Senate Finance Committee, said it was "contradictory" to not reduce Medicaid's enrollment - which is at record levels - and also give workers a raise while cutting billions elsewhere.

"We can't provide the Cadillac of services and provide wage increases, and then cut everything else," DeFrancisco said. "There's just something basically unfair about it."

Union officials disputed the $416-million figure. Helgerson said there weren't enough data to make a cost estimate.