Healthcare (Medicaid)

S 8902 amends New York's social services law to ensure that medical assistance recipients (such as Medicaid beneficiaries) cannot access school-based health center services through managed care programs until at least April 1, 2026. The bill adds a specific provision requiring these services to be provided outside of managed care arrangements during that period. This directly affects medical assistance recipients who use school-based health centers and the managed care organizations that coordinate their care. The law takes effect immediately, but the amendment expires when the underlying section of the law is repealed.

Authorizes the state to allow counties to opt out of the county cost of medical assistance payments to any new enrollees who have either never received such benefits or who have reenrolled after a period of absence; directs the commissioner of health to apply for any and all federal waivers required to implement the provisions of this subdivision.

This bill caps payments to pharmacies for certain high-cost drugs. It requires that pharmacies receive no more than 2.5% of a drug’s total cost (including federal benchmark pricing) plus any authorized dispensing fees, but only for drugs with a federal cost benchmark exceeding $670. The rule directly affects pharmacies dispensing these specific high-cost medications under New York’s Medicaid program. It aims to standardize reimbursement without altering existing dispensing fee structures.

This bill (S 3131) requires that Medicaid optional benefits for adults over 21 years old must not exceed the minimum health insurance benefit levels required for private health plans under state law. It directly affects adult Medicaid beneficiaries receiving optional services (like dental or vision care), excluding long-term care. The key mechanism sets a cap on these benefits to align them with private insurance minimums, aiming to reduce state Medicaid costs. Implementation requires federal approval for plan changes and gives the health commissioner authority to create necessary regulations.

Directs the commissioner of the department of health to apply for a waiver to implement a work requirement for able-bodied adult recipients of Medicaid.