The New York Times, September 20, 2010

Describing Medicaid as a “massive program” whose growth threatens the state’s finances, Lt. Gov. Richard Ravitch is calling for significant changes in New York’s health care benefits for the poor and disabled, lobbing a volatile issue in the midst of the campaign for a new governor.

In a report to be released on Monday, Mr. Ravitch says the state should remove control of the rate-setting process for Medicaid, the joint state and federal health insurance program for the poor, from the Legislature to reduce the influence of politics.

He also calls for limits on medical malpractice awards and for the re-examination of rules that allow middle-class families to shelter assets so they can qualify for coverage.

Although the report does not suggest a cut in benefits, it notes that New York has among the most liberal definitions of eligibility.

While Medicaid began as a program mainly for people on welfare, the report says, the state program now covers many of the working poor, including childless adults, as well as long-term care for the disabled that includes visiting nurses, and help with bathing, cooking and housekeeping.

Almost one in four New Yorkers now receive Medicaid, the report said, making it the largest purchaser of health care in the state and consuming a third of all the money the state spends every year.

“We have been extremely generous in expanding the eligibility of care, and we have a long-term care program that nobody else does,” Mr. Ravitch said in an interview on Sunday. “The rate of growth is critical to trying to deal with the enormous deficit the state faces.”

Mr. Ravitch is seeking to address a crisis that many states have been grappling with. In a report released in June, the National Governors Association said that starting in 2014, the federal health care overhaul will add 16 million people to the 60 million already enrolled in Medicaid, and warned that changes in the way the benefits are delivered “will be crucial to contain program spending.”

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