You Win Some, You Lose Some: Hits and Misses in New York’s Budget

New York State passed its $237 billion fiscal year 2025 budget over the weekend, after lengthy negotiations, an eclipse, and an earthquake. Some issues dominated the headlines: housing, public safety, cannabis, mayoral control of New York City schools. On the health side, discussions about Medicaid rate hikes and a potential hospital closure in Brooklyn took up a lot of oxygen. A measure to guarantee continuous public health insurance coverage for children up to age six, and another to eliminate cost-sharing for insulin among New Yorkers in State-regulated health insurance plans, are being celebrated.

Other items that didn’t get as much attention are also worth mentioning. Some are poised to have a big impact on our health system and on the lives and health of New Yorkers. Others fall short. And some were left out entirely.

Here are some of the hits and misses — and mixed bags — in this year’s State budget.

The hits:

  • Protections against medical debt. New York has been a national leader with policies that protect consumers from unfair practices related to medical debt. Last year, New York became only the second state in the nation, after Colorado, to prohibit agencies from including medical debt of any amount on credit reports. The 2025 budget builds on that earlier success: for example, it prohibits hospitals from suing patients with incomes below 400% of the federal poverty level for medical debt. The legislation also expands hospital financial assistance programs and limits the size of monthly payments for medical debt.
  • Support for doulas. Doulas have been shown to improve birth outcomes, especially for people of color. The budget includes a standing order for Medicaid beneficiaries to receive doula services during the prenatal period and up to one-year postpartum, removing the barrier of requiring a clinician referral to receive doula services. It also establishes a grants program to provide support for recruitment and training of community-based doulas, with a focus on bilingual doulas and doulas from historically marginalized communities. One item that did not make it into the final budget was extending doula services to New Yorkers enrolled in the Essential Plan.

A couple of areas saw mixed results:

  • A small victory for telehealth, with a big gap still remaining. New York had authorized several temporary measures to expand and support telehealth access during the COVID-19 pandemic. (A recent brief from Manatt Health goes into more detail on these policies.) The budget extends coverage and payment parity of telehealth with in-person services through 2026. That should help meet patients’ and providers’ desire to continue the use of telehealth as a convenient and flexible approach to care. On the flip side, the budget did not address a gap in payment for telehealth services delivered by community health centers. As it stands, if neither the provider nor the patient is physically on-site at a clinic, health centers effectively see their payment for that visit reduced by about two-thirds. Requiring that the physician or patient be at the clinic undermines the premise and flexibility of telehealth. Behavioral health and substance use disorder clinics both receive full payment for telehealth services; community health centers should be treated the same.
  • Ongoing support for expanded — but not universal — free school meals. Providing free school meals is proven to reduce food insecurity, improve mental and physical health, boost academic performance, and increase educational and economic equity. Last year’s budget greatly expanded and funded free meals for students. Approximately 83% of public-school students across the State can now receive free meals and that will continue. But support still falls short of universal, leaving out more than 320,000 children in nearly 660 schools across New York State. Beyond school meals, we saw some better alignment across a range of anti-hunger programs. But when an estimated 1 in 10 New Yorkers are experiencing food insufficiency, we need to do more.

And one clear miss:

  • A lack of action to expand the role of Medical Assistants. Medical Assistants, or MAs, are members of a primary care team, and they’re one of the fastest-growing segments of the health care workforce. New York lags every other state in making the most of Medical Assistants’ potential. Most notably, we are the only state that does not allow MAs, under the supervision of a clinician, to administer vaccines. Permitting MAs to administer vaccinations increases the number of health care professionals that can protect New Yorkers against disease. It also frees up doctors and nurses to use their time, expertise, and training to meet more complex patient care needs. New York missed a key opportunity by not expanding the role of MAs; we should be a leading state on health, not at the very back of the pack.

The budget provides a roadmap to understand the State’s top priorities, but it isn’t everything, or the only thing. Lawmakers will continue to hammer out policy proposals in the remainder of the legislative session, and some of the gaps we saw in the budget could be addressed. Policymaking and budgeting is about compromise — it’s rare that everyone gets everything they want. But for a moment, let’s celebrate the wins. And then let’s get back to work to do even more.

By David Sandman, President and CEO, New York Health Foundation
Published on Medium on April 25, 2024

NYHealth Testimony on Investing in Fresh, Healthy, Culturally Relevant School Meals

NYHealth Senior Program Officer Julia McCarthy submitted the following testimony to the New York City Council Committee on Education’s preliminary budget hearing on March 18, 2024. In her testimony, she emphasized the opportunity to improve students’ health and advance health equity through nutritious, culturally responsive, and delicious school meals:

The New York Health Foundation (NYHealth) is a private, independent foundation that seeks to improve the health of all New Yorkers, especially people of color and others who have been historically marginalized. Our Healthy Food, Healthy Lives program works to advance policies and programs that link New Yorkers with the food they need to thrive. Supporting nutritious, culturally responsive food in New York’s public institutions, including schools, is a core approach of our program.

NYHealth has a lengthy, successful history of improving both access to and the quality of school meals. Notably, NYHealth grantee Community Food Advocates (CFA) helped to secure universal school meals for the City’s 1.1 million public school children in 2017; just last year, CFA secured a State subsidy to help more schools provide free meals to all students. The Foundation has also supported efforts to increase State funding for farm-to-school programs that increase local products in school cafeterias.

NYHealth has partnered with multiple City agencies, including the New York City Department of Education’s (NYC DOE) Office of Food and Nutrition Services (OFNS), to procure better quality food— including products that fall under the Good Food Purchasing Program (GFPP). GFPP encourages public institutions to purchase food that supports nutrition, local economies, and environmental sustainability, among other values. The City has also partnered with Wellness in the Schools (WITS) to improve the appeal of school food and cafeteria environments, working to fulfill the promise of free lunch for all by transforming meals to be healthier, fresher, and more culturally relevant.

In the context of this impressive progress, we would like to highlight the critical importance of continued investment in fresh, culturally relevant meals in schools.

School Meals Reduce Hunger and Improve Dietary Health
Considerable evidence shows that school meals improve dietary quality for children who are at risk of hunger. School meals mitigate food insecurity among low-income students and are often the healthiest parts of students’ diets, across all income levels. Students who eat school meals consume more plant-forward food during mealtimes and have higher quality diets compared to students who don’t consume school meals.[1],[2] Nutritious school meals can also support students’ academic performance.[3] Even in the face of budget constraints, high-quality school meals are a necessity, not a luxury.

NYHealth’s own research on food insecurity and food insufficiency (a more severe and short-term version of food insecurity) further emphasizes the need in New York. Our forthcoming analysis shows that hunger spikes for households with children during school closures, like winter and summer breaks. Another NYHealth analysis conducted during the COVID-19 pandemic shows that school meals were the most commonly used food access point for New Yorkers in need.[4] Access to high-quality, culturally responsive, healthy school meals is also essential for advancing health equity. In New York City schools, 25% of students are Black and 42% are Hispanic or Latino, but school food often doesn’t meet those students’ needs and preferences. Our analysis shows that, whereas 81% of white families participating in school meals say they approve of the variety of food offered, only 58% of Hispanic families and 45% of Black families approve.[5] A forthcoming NYHealth data brief shows that, in 2023, food insufficiency rose for Black and Hispanic households across New York State; with growing need, healthy and appealing school meals are a lifeline for families struggling to put food on the table.

New York City’s Commitment to Healthy School Food Is Making a Difference
NYHealth applauds OFNS’s dedication to providing healthy school meals to the City’s students. OFNS recently committed to transforming school meals from frozen and pre-prepared items to freshly cooked meals. Partnering with WITS, it is redirecting the City’s school food menu and purchasing agreements toward fresh foods.

In 2022, NYHealth made a grant to support WITS in its partnership with OFNS to implement freshly cooked meals in New York City schools. This partnership launched the first NYC Chefs Council, comprising approximately 20 chefs and food activists to develop recipes that reflect the diversity of New York City’s students. OFNS and WITS developed and tested 100 plant-forward, culturally relevant meals that can be cooked from scratch ingredients from the NYC DOE’s procurement list. The new menu items are now available in all 1,200 New York City public school buildings. Additionally, the partnership led to scratch cooking training in 112 of the City’s more than 1,800 schools and has plans to expand training for more schools in the future. As a result, school cooks in these schools are now ready and able to prepare new healthy menu items using fresh ingredients. An earlier evaluation of the impact of the WITS program on New York City school lunches for elementary school students found that participating students consumed more fruits and vegetables.[6]

New York City Can Build on School Meal Successes
OFNS has worked relentlessly to implement new approaches to ensure students have the food necessary to maximize their health and succeed in school. Preserving these gains is critical. Proposed City budget contractions reflect precarious economic times, which means kids need nutritious school meals more than ever. The proposed $60 million cuts in OFNS’s budget may mean children don’t have continued access to the healthy meals they need to thrive.

The City Council has pledged to continue to improve the healthfulness and cultural responsiveness of meals in schools. Making good on that promise means continued support for OFNS to do just that. NYHealth appreciates the City’s shared understanding of school meals’ role in food security and dietary health, and its commitment to supporting these important programs. We look forward to continued partnership with the City and anti-hunger organizations to improve students’ health and advance health equity through nutritious, culturally responsive, and delicious school meals.

 

[1] Fox, M.K.; Gearan, E.; Cabili. C.; et al. “School Nutrition and Meal Cost Study, Final Report Volume 4: Student Participation, Satisfaction, Plate Waste, and Dietary Intakes,” U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support; 2019. https://fns-prod.azureedge.us/sites/default/files/resource-files/SNMCS-Volume4.pdf, accessed March 2024.

[2] Kinderknecht, K.; Harris, C.; Jones-Smith, J. (2020). Association of the Healthy, Hunger-Free Kids Act with Dietary Quality Among Children in the US National School Lunch Program. Journal of the American Medical Association. 324(4), 359-368.

[3] Pucher, K.K.; Boot, N.M.W.M.; De Vries, N.K. (2002). School health promotion interventions targeting physical activity and nutrition can improve academic performance in primary- and middle school children. Health Education. 55(5), 372-391.

[4] New York Health Foundation. “NYHealth Survey of Food and Health,” August 2022.  https://nyhealthfoundation.org/resource/nyhealth-survey-of-food-and-health-2022/, accessed March 2024.

[5] New York Health Foundation. “NYHealth Survey of Food and Health,” August 2022.  https://nyhealthfoundation.org/resource/nyhealth-survey-of-food-and-health-2022/, accessed March 2024.

[6] Koch, P.A.; Wolf, R.L.; Trent, R.J.; Ang, I.Y.H.; Dallefeld, M.; Tipton, E.; Gray, H.L.; Guerra, L.; Di Noia, J. (2021). Wellness in the Schools: A Lunch Intervention Increases Fruit and Vegetable Consumption. Nutrients, 13(3085). https://doi.org/10.3390/nu13093085.

Saving Lives: Steps Forward and Steps Backward

If you know someone who’s died of a drug overdose, you are far from alone. A new study from the esteemed RAND Corporation is shocking; it finds that 2 in 5 Americans know someone who’s died of a drug overdose.

Here in New York, the problem is only getting worse. More than 5,100 New Yorkers died from an opioid-related overdose in 2022 alone. That same year in New York City, a record number of people died of overdoses; fentanyl was involved in the vast majority of those fatalities. I’ve written before that it’s become almost commonplace to see people overdosing publicly in New York.

One bright spot in this darkness is OnPoint NYC, which operates the only two Overdose Prevention Centers (OPCs) up and running in the United States. (I’ve written about OPCs before, here and here.) These centers are clinical, safe, hygienic spaces where people can use drugs under the supervision of trained professionals. They provide medical and social services like free meals, counseling services, and showers.

Most importantly, they work. In just their first year of operations, the OnPoint sites prevented more than 600 overdoses in nearly 50,000 visits.

Despite their proven ability to save lives, the future of OPCs remains in limbo. For every step forward, it also feels like we are taking a step backward.

In the positive column:

  • New York City soon won’t be alone. The Providence City Council recently approved Rhode Island’s first OPC, which is expected to open later this year.
  • OPCs don’t harm their neighborhoods. New research in Journal of the American Medical Association examined the East Harlem and Washington Heights neighborhoods that are home to New York City’s OPCs. It found “[n]o significant changes…in violent crimes or property crimes recorded by police, 911 calls for crime or medical incidents, or 311 calls regarding drug use or unsanitary conditions observed in the vicinity of the OPCs.”
  • New York State’s Opioid Settlement Fund Advisory Board has repeatedly expressed support for expanding OPCs across the State, including to rural areas, citing their role “in saving lives and offering another day to drug users.” And it specifically recommends using opioid settlement funds to support OPCs. New York State lawmakers have repeatedly introduced legislation to establish safe consumption sites, since at least 2021.

On the other hand:

  • OPCs have failed to spread widely. California, Colorado, Massachusetts, and Vermont have taken steps in recent years to authorize OPCs, but all have fallen short. Philadelphia was set to open the very first OPC in the nation back in 2019, but the federal Justice Department sued to stop its launch.
  • The main impediment to scaling OPCs is the lack of public funding. It was widely expected that the Biden Administration and its DOJ would drop opposition to OPCs, paving the way for wider adoption and government financing. But the Philadelphia case was still dragging on at the end of last year. It’s unlikely that there will be any meaningful federal action in an election year.
  • In light of these stalled federal efforts, Governor Hochul has refused to allow opioid settlement funds to go toward OPCs. And New York’s legislative bills have failed to gain broad traction.

So here we are: stuck in second gear while the death toll mounts. It will take a lot more than OPCs to curb the opioid epidemic. Harm reduction takes many forms, and New York is doing a lot of things right, like making naloxone more widely available and expanding access to substance use treatment programs. There is even a glimmer of hope in the data. New York State’s Opioid Data Dashboard shows that high schoolers’ rates of heroin and other drug use are holding steady or even dipping a bit. That could mean fewer New Yorkers are getting hooked on opioids in the first place.

But there’s no time to waste. Every three hours, someone in New York City is dying of an overdose. One step forward followed by one step back is not going to cut it. If we are serious about stopping the opioid crisis, we need bold action. We need courage.

By David Sandman, President and CEO, New York Health Foundation
Published on Medium on February 27, 2024

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