Lawmakers and advocates deliver valentines to Gov. Hochul’s office about Medicaid Pharmacy carve-out

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ALBANY, NY (WENY) — In the spirit of the holiday, some lawmakers and advocates traveled to Albany to deliver a giant valentine to the governor–pushing for a compromise against the carve-out of pharmacy benefits from NYRx, a Medicaid program.

The carve-out would essentially limit funding for safety net providers who provide health care to state residents regardless of their ability to pay. And some advocates feel strongly that this change to the Medicaid program will directly harm New York communities–particularly those living with HIV and AIDS.

“This change on April 1, is going to directly lead to deaths in New York state,” said Perry Junjulas, Executive Director of the Albany Damien Center, a social services organization.

The carve-out originated in the legislature’s 2020 state budget and essentially transitions enrolled Medicaid members from Medicaid Managed Care plans to Fee-For-Service programs. The 2020 proposal delayed implementation for two years. It expires this upcoming April.

Sen. Gustavo Rivera (D-33rd Senate District) said this change to the Medicaid program was proposed originally in an effort to try and save the state money but many New Yorkers could suffer because of it.

“The impact that it would have on the providers who use this program is a way to save money and more importantly invest those savings into the lives of vulnerable populations,” Rivera said.

While other lawmakers said this change is an effort to try and increase transparency.

“This is an attempt to really restart the conversation. To make sure that every individual–regardless of what disease they may or may not have– is all treated fairly and equitably. And at the same token driving the resources, saving the resources so the state can re-invest it in these safety net providers,” said Assembly Member John McDonald (D-Assembly District 108).

Any policy or funding changes to this Medicaid program will have to go through the final budget, which is due on April 1.


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