Lance's Corner

Governor Hochul Announces Dental Plans

Jan 14, 2025

Per the notice below, Governor Hochul has announced her health care ideas for 2025, including her plans for dentistry.

Governor Hochul Proposes New Initiatives to Strengthen New York’s Health Care System and Expand Access to Care

Improving Outcomes for Individuals Struggling With Obesity Through Access to Life-Changing GLP-1 Medications

Mandating Minimum Standards for Standalone Dental Plans To Simplify and Improve Care for Consumers

Ensuring Access to Emergency Medical Care and Extending the Safety Net Transformation Program

Providing Air Conditioning Units for Pregnant New Yorkers and People With Chronic Conditions

Governor Kathy Hochul today announced initiatives aimed at improving health care coverage and fortifying New York’s health care system as part of her 2025 State of the State.  These initiatives include expanding access to life-changing GLP-1 medications for individuals struggling with obesity, simplifying and improving dental coverage for consumers, and expanding coverage for air conditioning units for pregnant women and people with chronic conditions.  Additionally, the Governor will introduce new legislation to ensure all New Yorkers have access to emergency medical services and expand the Safety Net Transformation Program.

“As we continue our post-pandemic recovery, it’s critical to make investments and innovations in our health care system,” Governor Hochul said.  “This year our health proposals will put more money back in the pockets of New Yorkers and ensure they have access to affordable, high-quality care.”

Increasing Availability of Lifesaving Obesity Medications

Obesity contributes to increased risks of diabetes, heart disease, cancer and other serious conditions, and tackling obesity remains a challenge in New York.  Cost barriers have left many Medicaid patients without access to life-changing medications, including Wegovy and Ozempic — glucagon-like-peptide-1 (GLP-1) receptor agonists that have transformed obesity treatments.

To address this, Governor Hochul is directing the Department of Health to evaluate access to GLP-1 drugs for Medicaid members at high-risk of major adverse cardiovascular events, such as heart attack or stroke.  New York will also work with other states to pressure drug companies to bring down prices of GLP-1s and address the inequitable access to these life-changing medications, and make them more available to more New Yorkers.  These initiatives will aim to improve outcomes for individuals struggling with obesity and reduce the health inequities preventing access to these treatments.

Expanding Access to Dental Care

The link between dental care and overall health is well-recognized, yet many New Yorkers face significant challenges in accessing vital oral health services.  Governor Hochul plans to establish minimum standards for dental plans available in the Marketplace and explore the use of federal 1332 Waiver funding to subsidize the costs of purchasing dental plans.  To enhance access even further, Governor Hochul will introduce legislation that permits dental hygienists to work in a broader range of settings.  In addition, the Department of Health will take steps to encourage health plans to reinvest funds into innovative initiatives that improve dental care availability.

Accessing dental care poses challenges for New Yorkers.  Nearly half of adults with health care debt owe at least some of this debt for dental care.  Unlike medical plans, dental plans lack consistent standards under the Affordable Care Act, leading to confusion over costs and benefits.  There are no minimum coverage standards for dental plans, making it difficult for the 260,000 New Yorkers enrolled on the individual Marketplace to navigate varying benefits and costs.  To address this, New York will introduce a Standard Adult Dental Plan in 2026, requiring stand-alone dental plans to meet minimum standards to simplify and improve dental care for consumers.

Ensuring Access to Emergency Medical Services

New York has taken major steps in the last two years to buttress the state’s Emergency Medical Services (EMS) system.  However, there are areas across the state where EMS services are not consistently and reliably available.

Governor Hochul will introduce legislation defining EMS as an essential service and requiring counties to ensure all residents have adequate access to these services.  Such legislation will also require counties to develop a county EMS mapping that will allow New York to identify and fill gaps in coverage, coordinated statewide by the State EMS Task Force, which was established by Governor Hochul in 2022.

Extending the Safety Net Transformation Program

Safety-net healthcare institutions in New York face challenges in maintaining resilience and stability.  To address this, in 2024 Governor Hochul established the Safety Net Transformation Program, providing financial support and regulatory flexibility to encourage strategic partnerships, and strengthen hospital systems.  In its first year, the program experienced demand that far exceeded the available funding.

To meet this demand, Governor Hochul will allocate additional resources to the program.  This commitment will support worthy applications and foster new partnerships to stabilize and strengthen New York’s safety-net hospitals for the future.

Expanding Access to Air Conditioning Units for People With Chronic Conditions

In New York State, climate change is intensifying the severity, duration and frequency of extreme heat events.  In 2024, Governor Hochul announced an expansion of coverage for the purchase, delivery, and installation of air conditioners in the Essential Plan for members at significant medical risk due to asthma.  To build on this achievement, Governor Hochul plans to broaden the eligibility criteria for air conditioning units to include pregnant women and those with additional health conditions aggravated by extreme heat, such as diabetes, cardiovascular disease, and hypertension.  This expansion will take effect in 2026 and is projected to ensure that up to 15,000 additional Essential Plan enrollees can access air conditioning units, significantly mitigating the effects of extreme heat on vulnerable populations.

New York State Health Commissioner Dr. James McDonald said, “These proposals, including expanding access to dental care, medications to treat obesity, and improving access to air conditioning units, illustrate the Governor's commitment to address real problems of New Yorkers and help them live well.”

 

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc