Fighting to save the state’s Health Home program

The Governor's budget for fiscal year 2025 included significant budget cuts to programs. The Health Home program, a service that currently provides for 170,000 New Yorkers, is on the guillotine. 

Health Home focuses on individuals in the Medicaid program who need coordinated care. Members in the program suffer from mental and physical illnesses like HIV, sickle cell disease, and depression. The program finds qualifying constituents through hospitals who report individuals who repeatedly go to the ER for non-ambulatory services. These individuals do not have general practitioners or care plans.

iHealth, a coalition of twenty-one community-based organizations providing specialized care management services across New York State, is appealing to the state Legislature to reject this proposed cut. 

City & State caught up with Matthew Lesieur, executive director of iHealth, to see why cutting the program will lead to many New Yorkers losing access to coordinated care. 

This interview has been edited for length and clarity. 

Why is iHealth appealing to the state Legislature to reject this proposed cut?

Our coalition really believes that the health home program, which has been subjected to a series of cuts over the past several years, is at a stage where any further cuts for a lot of my members would essentially be the death knell of their ability to continue to operate this service. Last year, the enacted budget included a significant cut of $100 million to be distributed over two years, which really forced us to make some major changes to the program. And now we are at a stage where the funding levels are really challenging for us. For a lot of our providers (ihealth) and a lot of providers in the health home program, another cut really is going to get to the bones and to a point where we just don't see how the program would be sustainable with any further cuts.

What has happened in the past when the Health Home program had budget cuts? 

There was definitely a higher caseload for certain workers. But what is really dramatically happening is the state has narrowed down who they believe should be eligible to receive this benefit. And so what we've seen is the size of the program has over several years been reduced in response to changes the state has made and in response to past budget cuts. The budget that was enacted last year included yet another administrative burden for providers in the form of a new screening tool that everyone must use. Nevermind the admin burden of the screening tool on caseworkers, it's really been designed to compel individuals in the program to find care somewhere else. 

We are starting to see shrinking caseloads and shrinking enrollment which ultimately results in reductions of staff. I have seen several smaller agencies that provide this program being forced to literally close their doors or being forced to make some unfortunate choices around not operating the program at all. 

We are starting to see the program dwindle in size. We're seeing some of the unique providers that really offered a niche service to certain impacted communities, no longer able to provide services to those communities. Funding is now at a point where I can't– the health department has not indicated what they would do to implement a cut of 125 million. And there is no policy attached to this next level of cuts. In the past at least, while we may not have always agreed, there was at least a policy decision behind the change in spending. This year it just seems to be a budget slash with no meaningful thought on exactly what that would mean for people in the program or exactly how it would be implemented. So we are sort of scratching our heads saying, “another cut? What exactly is left that they think they can cut from the program”?

For some of our readers who may not know much about the Health Home Program, why is it important and what does it do for New Yorkers? 

It's a very unique program that focuses on individuals in the Medicaid population who generally speaking have two or more chronic conditions or are living with a single qualified condition, like HIV or serious mental illness, and are really having trouble navigating the healthcare system. And they've been identified to be in and out of the emergency room a lot and not connected to a doctor. In and out of housing stability and having food insecurity. We're talking 170,000, a really small subset of the Medicaid population that has been identified as people who are in and out of emergency rooms a lot, unconnected to care, and not seeing their doctors. The program identifies them and connects them with a care manager or care management team. The program works with those individuals to address all their social care needs which are causing them to not really maximize how they're managing their illness and allow them to return to a more stable quality of life. We've seen some good data that's come out of the health department that has shown that it has significantly reduced in this population who stays in the program significantly reduced their admissions to hospital and their usage of emergency room care. 

How will the proposed cut wipe out the Health Home program?

Well, if a cut of $125 million goes through…There's two challenges with answering your question. One is that the health department has not signaled to us that they have a policy or a plan for how to address a cut of this magnitude. So there are questions around whether they will slash people from the program or cut reimbursement rates. Would they narrow down who is entitled to receive this benefit? These are all completely unanswered because we don't know what they would do with a cut of this magnitude.

But when you see that the current appropriation in the governor's executive budget is $196 million and they're proposing a cut of $125 million, what is left is crumbs at the table. So I would foresee most people in the program being kicked out of the program. I would foresee most providers not being able to function in this environment. Seeing that there's 170,000 people in the program and that includes 35,000 kids–they would be left without services.

What would be a sustainable budget?

I think the funding from last year sort of reached the point of sustainability. Last year, which was a two year Medicaid budget as opposed to this year being a one year Medicaid budget, the funding was at $424 million. That to me was sort of our bare bones level. Of course, this year is different because the funding is for one year, not two. But we feel like we're sort of at the point where another cut really does start to impact who's enrolled in a program and which provider can function in this program.

Who are the majority of the recipients in the health home program? 

The health department has recently started to produce some data on the program. It's still not perfect. What we do understand is that of the population that's being served by the health home program about 29% are identified as black non Hispanic. 28% are identified as Hispanic and only a quarter are identified as white of non Hispanic origin. There is a small portion that's unknown and about 3% are Asian Pacific Islanders. So what those numbers tell you is that over half the program is providing services to communities of color. Everyone in this program is obviously eligible for Medicaid. The most prevalent disease or chronic diseases that this population is managing, beyond the single qualifying criteria of HIV, diagnosed serious mental illness, or sickle cell disease are hypertension, hyperlipidemia, chronic anxiety, diabetes, major depression, obesity and asthma.

Any remaining thoughts?

When you asked the question about what was the ideal funding level, I said that last year was sort of kept this sort of at the bare bones. My challenge with even answering the question is that there's 170,000 people removed from the program. But we actually think there are a lot more people in Medicaid, who, if they were properly identified and screened, would be eligible for this service. So while funding last year $424 million allows it to be sustainable. If you really wanted everyone in Medicaid to benefit from the service as intended, you would probably see a lot more people on the program and the funding would actually be a lot higher.

Editor’s note: Matthew Lesieur reached out after the interview to say that iHealth believes that there are many who qualify for the program and have yet to be reached. The original state plan amendment identified 975,000 individuals who would meet criteria for the Health Home program - and that was out of a Medicaid population of 5.4 million. Today there are over 7 million New Yorkers enrolled in Medicaid. There are currently 170,000 individuals enrolled in the program– highlighting that the state has not fully identified everyone who is eligible for this benefit.