NYC Health Department Notes on the Governor's Executive Budget School-Based Health Centers DOHMH requests a permanent carve-out for school-based health centers (SBHCs) to allow them to bill Medicaid directly. SBHCs currently have a one-year carve-out of Medicaid Managed Care until July 2017. + SBHCs provide comprehensive primary medical care, dental care, and mental health services at no out-of-pocket cost to all students, regardless of insurance status. This has increased access to. health care for minority youth, improved school attendance and performance, reduced Emergency Room visits, prevented unnecessaty hospitalizations, and lowered total annual Medicaid expenditures. + There are currently 145 SBHCs serving over 345 schools in New York City. The City is investing $80 million in capital funds for new SBHCs. Without a permanent carve-out: + Inadequate managed care capitation rates will result in funding shortfalls and leave many SBHC costs uncovered. + Medicaid Managed Care billing will reduce revenue to SBHCs due to administrative challenges involving credentialing, contracting, billing and claims processing, resulting in the closure of some SBHCs. + DOHMH would be required to provide nurses to sites without an SBHC at a substantial cost (as high as $15 million) to the City and State. Essential Plan Premium DOHMH requests that health insurance premiums for low-income New Yorkers remain at their current rates. + A premium could lead to people cycling on and off health insurance (“churning”) due to affordability issues, which could cause disruptions in access to care, especially given the current uncertainty over the Affordable Care Act. + Low-income New Yorkers (individuals between 138% and 150% of the federal poverty level) have historically had health insurance with no premiums in New York State (NYS), even before the Affordable Care Act. + According to the NYS 2016 Open Enrollment Report, 12% (ust over 45,000) of the 379,559 Essential Plan enrollees had incomes between 138% and 150% of the federal poverty level. HealthArticle 6 Cut Article 6 provides partial reimbursement for city tax levy (CTL) funding to support local public health activities and services in six core service areas: Community Health ‘Assessment, Family Health, Communicable Disease Control, Chronic Disease Prevention, Environmental Health, Emergency Preparedness and Response. ‘The proposed cut would reduce reimbursement by 7% (from 36% to 29%) for New York City only. This translates 10 less revenue to support essential public health programs. If State aid is reduced, the NYC Health Department wil Reduce the number of asthma counseling ‘staff, which can result in an increase of emergency department visits, hospitalizations and even fatalities of children East Harlem, Central Harlem ‘and South Bronx. Close one of eight STD clinies, resulting int east 6,000 sexually transmitted a infections not getting treated, and at least 30 people living with HIV not getting diagnosed and treated. Reduce the number of flu vaccinations ‘administered in our City’s only immunization clinic, resulting in increased fiuiliness ‘among populations that rely on DOHMH clinics, such as recent immigrants. Eliminate testing for Zika virus, resulting in delayed or missed diagnoses. Diminish drinking water safety, and recreational water and building water supply oversight, including cooling tower enforcement to prevent diseases like Legionellosis. Reduce the number of TB public health advisors, and conduct fewer and less-intensive investigations Into the contacts of active TB cases. This could result in missed noses and future TB outbreaks. ‘This NYC-specific cut is based on the assumption that, Unlike other counties, NYC can directly access other forms of public health funding, including from the CDC. However, federal funds are not fungible and may decrease under the new Administration (e.g., a repeal of the Affordable Care Act will rescind the Prevention and Public Health Fund, which is of the CDC's budget). need to: Reduce the number of disease detectives who assist with communicable disease surveillance and public health ‘emergency response, Eliminate the Connecting Adolescents. ‘to Comprehensive Healthcare (CATCH) program, which provides reproductive health services and education to nearly ‘50% of high school students. Eliminate operating funds for School-Based Health Centers, which provide primary care such as physical examinations, reproductive health services, screening, education and referrals. Distribute nearly 600,000 fewer clean syringes to drug users, increasing the risk of new HIV infections. Distribute 760 fewer naloxone kits to people at risk for overdose. Assuming a 10% fatality rate, about 19 lives lost may be lost to overdose, Reduce funding for tobacco control media ‘campaigns. From 2006 - 2013, DOHMH's anti-smoking campaigns have generated ‘over 600,000 calls for help quitting ‘smoking. This translates into over 60,000 future smoking-related deaths prevented,