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The governor made clear he's serious about reducing projected spending by $10 billion dollars, but Cuomo's budget plan hinges on some precarious elements. The governor is recommending nearly $3 billion dollars in Medicaid cuts in order to close the budget gap, but Cuomo does not detail which cuts he favors in the spending plan.
Instead, he's awaiting the results of a panel he's created of stakeholders, including hospitals, nursing homes, and health care workers. They are tasked with deciding on the appropriate cuts and are scheduled to report back by March 1st.
Betsy Lynam, with the watchdog group Citizen's Budget Commission says it's a new tactic.
"One of the strengths is that he is clearly trying a different approach," said Lynam, who described the spending plan as more of a "roadmap" with details left to be "ironed out" by the commissions.
The governor also wants to close a number of state prisons, to save money, but will leave it up to a panel of lawmakers and others to decide which prisons to close in order to achieve his goal of 3500 fewer beds. He does provide millions of dollars in economic aid for upstate communities that may lose the prisons they depend on for their local economies.
And he's budgeted for nearly half a billion dollars in savings from the state's workforce, but has not spelled out exactly what form that will take. The governor says as a last resort, he would lay off 9800 workers.
There are some potential weaknesses in the plan. The panels and commissions could fail to come up with solutions. Already one of the major stakeholders on the Medicaid redesign panel, the hospital lobby group the Health Care Association of New York, say the governor is asking for too much. The group's President, Dan Sisto, says it would take "alchemists, not policy wonks or providers" to make cuts of that magnitude without doing substantial harm to health care.
"We've all got to give it our best shot, because I certainly don't like to default," said Sisto, because, he said, that would mean the governor would impose the billions of dollars in cuts without input from the industry.
Lynam, with Citizens Budget Commission, says Cuomo's approach has some distinct political advantages. Even though some of the major players are already complaining, they can't point to specific cuts to rally against. She says it's much harder for health care groups to run TV ads showing emergency room closings and other dire consequences. Those tactics in the past brought previous governors to heel, and caused them to back down from proposed cuts.
Sisto, with the Health Care Association, agrees that if Cuomo is forced to make the cuts himself, groups will have less time before the April 1 budget deadline to organize opposition. He says the entire experiment of the Medicaid redesign panel is a risk and requires "a degree of good faith from both sides.
While some stakeholders are alarmed, the open ended Medicaid budget gives hope to others. Disability rights advocates say for once, they aren't the first group to see their services cut. Bruce Darling, with the Center for Disability Rights, says the redesign panel offers a chance to shift what he calls the "institutional bias" from more expensive nursing home and institutionalized care to community based services and home health care, which he says have been demonstrated to save money as well as please patients.
"We see this budget cycle as an incredible opportunity," Darling said. "We're really hopeful that drastic times will call for a drastic response that will right the system."
There's not much time left. The Medicaid panel has les than a month to figure out how to implement the cuts. State worker unions have until April 1st, when their contract expires, to come up with their alternatives to lay offs, and the prison closing panel has until May 1st to decide which facilities should close.