What the Federal Stimulus Package Means for New York State Department of Health Programs

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Drinking Water State Revolving Fund (DWSRF)

The Department of Health, in partnership with the Environmental Facilities Corporation (EFC), administers a grant and loan program to improve and rebuild public water supply systems. Municipalities and other organizations which operate public water supply systems are eligible to apply.

New York State expects to receive about $87 million from Stimulus funds. 50% of the money will be spent as grants, and 20% of the funding will be used for "green" projects. The grant requirement that municipalities match the funds received will be waived.

What this means for New Yorkers

There is a long list of public water systems that are already waiting for money to fund needed improvements, totaling about $2 billion of projects across New York. This funding will enable many more cities and towns to upgrade their water systems sooner than would have been possible without the stimulus funding.

Early Intervention Program (EIP)

The Early Intervention Program provides speech, hearing, and other therapies to developmentally delayed children from birth to the age of 3. It is run by the Department of Health and local health departments. Services are provided by agencies and individuals in local communities who have been approved by the Department. Over 70,000 children and their families are served by the Early Intervention Program.

New York State's Early Intervention Program received $11.8 million in funding in April and $14.6 million in August, 2009.

What this means for New Yorkers

The added funding will be used to pay for improvements to the information systems and operations of the Early Intervention Program. This will help to better coordinate the services families receive.

Health Information Technology (Health IT)

Even before the Federal Government provided the monies in the Recovery Act, the Department had set up the Office of Health Information Technology Transformation (OHITT), which is working with hospitals and practitioners in New York State to switch over to a system of electronic health records.

By the end of 2009, $2 billion of stimulus funding is expected to be made available to the National Coordinator for Health Information Technology. It would be used to support the implementation and development of electronic health records throughout the country.

What this means for New Yorkers

Since New York State already has OHITT in place, any funding received would be used to support and expand state initiatives.

Nationally, in addition to the $2 billion mentioned above, another $14 billion has been designated for promoting electronic health record-keeping for Medicare and Medicaid patients. This is a longer-term program that is not expected to begin funding until 2011. The amount of money New York would receive is yet to be determined.

National Coordinator for Health Information Technology (ONCHIT)

  • ARRA national funding: $2 billion

In its Program Implementation Plan released in mid-May ONCHIT has initially segmented its Recovery funds for the following purposes.

  • Privacy and Security, $24.285 million
  • National Institute of Standards & Technology, $20 million
  • Regional HIT Exchange, $300 million
  • Unspecified, $1,655.715 million

On August 20, 2009, ONCHIT set aside $564 million to be distributed to states or a state-designated organization through cooperative agreements which will be used to advance the necessary governance, policies, technical services, business operations and funding mechanisms for health information exchange, building off existing efforts to advance regional and state level towards nationwide interoperability.

On the same day, ONCHIT also announced that certain not-for-profit organizations are eligible to compete for $598 million in grants for the HIT Extension Program, Regional Centers Cooperative Agreement Program. Funds will be awarded through three cycles, with preliminary applications for the first round due September 8, 2009. More information on eligibility requirements and submitting applications.

Electronic Health Record (EHR) Technology

  • ARRA national funding: $14 billion

The Recovery Act provides for a 100 percent Federal financial participation (FFP) match for State expenditures for healthcare provider incentive payments to encourage the purchase, implementation, and operation certified electronic health record (EHR) technology. These incentives will be established at 85 percent of federally-determined "net average allowable costs" of such EHR technology, including support and training for staff, up to statutory limits.

The Recovery Act also established a 90 percent FFP match for State expenditures to administer this incentive program.

At the beginning of September, 2009, the Center for Medicaid and State Operations (CMS) issued preliminary guidance related to the State administration of the incentives, such as the requirements to ensure proper payments, to audit and monitor payments, and to promote the use of electronic health records.

Before administrative costs can claimed from CMS, the State must develop a State Medicaid Health Information Technology Plan subject to CMS review and approval. Guidance on this review process has not yet been issued.

CMS has not issued any guidance on the incentives other than outlining what steps must occur before payments are made, such as:

  • Adopt an initial set of standards, implementation specifications, and certification criteria to define "certified EHR technology,"
  • Establish State responsibilities to track "meaningful use,"
  • Issue guidance to ensure EHR systems are compatible, and
  • Publish proposed rules to implement the incentive program.

This timeline for implementation indicates that providers should not expect to receive incentive payments until FFY2011.

Medicaid Federal Medical Assistance Percentage (FMAP)

Medicaid is a health insurance program for people with limited income or who are elderly or disabled. It is paid for by a combination of federal, state, and county dollars. Until December 31, 2010, the federal government will increase its Medicaid contribution by a minimum of 6.2%. For New York State, that increase is expected to total $11.1 billion. States qualify for this increase if they had increasing unemployment after October 31, 2008. This will mean that the state and county governments will contribute a smaller percentage as their shares to fund the costs of Medicaid..

What this means for New Yorkers

Medicaid services will not be cut or limited. The state and counties will be able to afford their share of Medicaid costs without increasing taxes or cutting programs. This will be true even if more people need Medicaid because they have become unemployed. People who are moving from welfare to employment will be able to stay on Medicaid for a longer time while they are waiting for employer-sponsored health insurance to start.

Temporary Increase in Federal Medical Assistance Percentage (FMAP)

Prevention and Wellness Fund

Nationally, Stimulus funding provides $1 billion to the U.S. Department of Health and Human Services. This will be divided into at least three major areas: $300 million for immunizations (mostly for purchase of vaccines); $50 million for infection control and monitoring; and $650 for community programs to prevent chronic disease (such as heart disease, diabetes, high blood pressure, and other illnesses.) The Department of Health and Human Services has until the middle of May to present a detailed plan to Congress on how it intends to direct the spending of this money. New York State expects to receive at least $48 million.

What this means for New Yorkers

If the expected funding comes to New York, it will enable the Department of Health's immunization, diabetes, health risk reduction, and other chronic disease programs to expand their disease prevention and health education activities. It would also be used to support the Department of Health laboratories in researching and tracking infectious diseases.

Although the Department of Health and Human Services has not divulged all the details on how CDC intends to spend prevention and wellness funds, some opportunities have been announced.

  • ARRA national funding: $1 billion
    • $300 million:
      • $32 million to CDC for internal use:
        • To increase national public awareness and knowledge about the risks and benefits of vaccines and vaccine-preventable diseases
        • To provide tools and education for health care providers
          • CDC announced a competitive grant opportunity, open to public and private nonprofit organizations, for immunization cooperative agreement partnerships, total of $2.5 million, with applications due July 6, 2009, for three different purposes:
            • Provide Technical Assistance and Training for Immunization Coalitions and Health Departments
            • Develop and Implement Materials and Programs to Educate Nurses about Immunization Issues
            • Develop Vaccine Safety Communication Materials and Curriculum for Medical Residents
        • To monitor and assess the impact and safety of licensed vaccines
      • To states:
        • $200 million to purchase vaccines. NYS grant is $12.1 million which includes $4.6 million for NYC. NYS also received $3.8 million to administer the immunization program, both at the State and local health department levels. Excluding New York City, the other 57 counties received $1,7 of this award as additional funds for operational costs.
        • $50 million for noncompetitive, operational grants and vaccine distribution
        • $18 million for competitive grants for innovative approaches increasing the number of Americans who receive childhood vaccines and for improving reimbursement practices, including:
          • Supplemental funding totaling $600,000 for "best practices" for monitoring school vaccination coverage and exemption rates; open to current grantees only, including New York State and New York City
          • Supplemental funding available to current grantees, including New York City, for improving immunization information systems
          • New applications from single domestic institutions, or network human immunology profiling research groups
    • $50 million for healthcare acquired infection control and monitoring
      • From CDC: $40 million available to states through competitive grants to create or expand state-based healthcare acquired infection (HAI) prevention and surveillance efforts and to strengthen the public health workforce trained to prevent HAIs. Existing Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) and the Emerging Infections Program (EIP) competitive cooperative agreements will be used to make supplemental competitive awards to State health departments to carry out HAI activities.
      • From CMS: $10 million allocated to states to improve the process and increase the frequency of inspections for ambulatory surgical centers. Payments will be made to States separate from but in the same manner as operation of the Survey and Certification program using Federal Hospital and Supplementary Medical Insurance Trust Funds.
    • $650 million for evidence based clinical and community based prevention strategies
      • $373 million to local communities for the Communities Putting Prevention to Work initiative that will support evidence-based prevention strategies to combat the effects of obesity and tobacco use. Applications are due December 1, 2009.
      • $277 million to states (more information to be released by CDC at a later date.).
  • NYS share: $47.75 million estimated, over two years, based on per capita allotment
  • More information about the Prevention Agenda Toward the Healthiest State
  • More information about Immunization
  • More information about Infection Control

WIC

The Supplemental Food Program for Women, Infants, and Children, known as WIC, provides coupons for nutritious food for lower-income pregnant and breastfeeding women, infants, and children up to the age of 5. WIC is run by the Department of Health in partnership with over 100 local agencies, such as county health departments, clinics, and hospitals. Funding for WIC comes from both the state and federal governments.

For New York State, the increase in federal funding for WIC from the stimulus package totals $13.7 million: $5.5 million to meet food costs related to increased WIC caseload, and $8.2 million for miscellaneous technology grants.

What this means for New Yorkers

It's expected that more women and children will become eligible for WIC as more families face unemployment. The increase in federal funding will help cover the costs of food and of administering the program for a larger number of people. ARRA WIC funds were used in June 2009 to pay for food costs for over 106,000 women and children across all counties in New York. Payments tracked with caseload, with almost 60% of funds going to the five boroughs in New York City.

More Information