New York operates the largest network of programs for the poor in the nation. It serves more than 5 million Medicaid clients at a cost of $54 billion annually. New Yorkers receive Temporary Assistance for Needy Families and similar state welfare benefits and services at an annual cost of $4.1 billion.
The Supplemental Nutrition Assistance Program — formerly known as food stamps — reaches over three million New Yorkers at an annual cost of $5.5 billion. Hundreds of thousands more receive subsidized child care and child welfare services.
Yet these programs, often serving the same clients, are isolated from one another. They are increasingly moving towards differing systems for determining eligibility and issuing benefits. Such fragmentation is foolish, ineffective and costs taxpayers more.
There is a solution, but New York is ignoring it.
The Centers for Medicare and Medicaid Services, as part of the health exchange provisions under the Affordable Care Act, has made a one-time offer to states of 90 percent federal match funding, instead of the usual 50 percent, for system modernization. The temporary enhanced Medicaid funds would be available for integrating shared eligibility services among all those programs.
But New York has not applied for the enriched funds, which became available in 2011 and last through the end of 2015. Not doing so isolates Medicaid further from the other programs.
Medicaid, food stamps and TANF combine their eligibility and issuance under the state’s welfare management system, operated out of New York’s Office of Temporary and Disability Assistance. The state’s Office of Children and Family Services has separate systems for child care and child welfare.
The 90 percent federal funding would unify the delivery of these programs by using the largest program, Medicaid, as the platform for the technology and the unified eligibility system.
By not applying for the enriched funds, multiple fragmented systems will remain the norm. The Department of Health will operate a single system for Medicaid and other provisions of the Affordable Care Act such as the governor’s proposed new state health insurance exchange. OTDA will struggle to find adequate federal or state resources to modernize welfare management, which must continue to deliver food stamps, welfare and other benefits like home energy assistance payments. Similarly, OCFS must modernize its historically problematic child welfare system, Connections, and its subsidized child care system on its own.
A partnership of the three agencies led by the New York State Office for Technology, called the “functional road map,” discusses system coordination, but has yielded few results to date. Applying for the enriched match funding is not part of the road map.
To make applying for these 90/10 funds more appealing, New York recently received a small systems planning grant from the feds that could easily be used to develop a thoughtful proposal and accelerate the process of fully coordinating all these programs. But the clock is ticking on the temporary federal largesse with no application to date.
A hallmark principle of Gov. Andrew Cuomo‘s administration has been efficiency, coordination and smarter integrated government. He has adopted a number of ideas to consolidate agencies and combine certain shared functions across agencies recommended by his Spending and Government Efficiency Commission.
But, the failure to access this enriched federal funding, which is in synch with his stated goals and will save money, is a major lost opportunity. Why hesitate any longer?
As the noted rocker Roy Orbison once said, “Oh, what a crying shame.”
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