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Community Action the weekly Health and Welfare report produced by the community council of Greater New York the planning and coordination group for health and well first of us is this week's topic where do we stand on title mind to Medicaid in New York City. Or moderator for this program Ted old factory editor of better Tom Now here is Mr Thackeray. Rock on to community action I'm Ted factory and the community Council's moderator for today's discussion of Perry stand in the city on Medicaid title length team of the medicare medicaid act with us today I had to talk about the city's Medicaid program are Dr Howard J. Brown. And the New York City Health Services administrator as well as the commissioner of health Dr Brown. Thackeray Mr Harry Jay Bakker the executive secretary of the Committee on special studies of the New York Academy of Medicine first black and Dr James G. Houghton and the city's first deputy health services administrator. And a man who wears many other official hatch as well but that one kind of covers a. Fresh new role for being with us Dr Brown Suppose you start our discussion today by telling us briefly what Medicaid is. Perhaps to whom it roughly applies in New York City and how the average citizen can find out whether he's eligible to get it. Well Medicaid is a rather complicated bit of legislation which as you mentioned originated in the Social Security amendments so-called Medicare minutes of last year and it's been connected into state form by the New York State legislature. Is intended to provide relatively complete medical assistance to needy people in referring to people who file able often to provide for the common assessors of life cannot be on public assistance cannot pay for necessary medical care now the old debility standards are really quite complicated and involve a number of individual considerations a person who wishes to apply may go to the local welfare office. This week we will have people in the city hospitals and other hospitals in growing Dr Horton is our is administering the Medicaid program for the Health Services Administration Well perhaps I can be a little bit more specific about who is eligible by giving one or two examples. Person who is employed. And who earns twenty five hundred dollars a year or less is eligible for this program and this is twenty nine hundred dollars of net income and that income is defined as income after state and federal income taxes and health insurance and. Payments made under court order. A person who is not employed for example or retired person who has assets or income of twenty three hundred dollars a year or less a pension for example of twenty three hundred dollars a year or less would also be eligible you're not talking about single people or people no other that's right now for the index family that we use in computing the. Ability to a family. In which one person was employed could have income of six thousand a year after these deductions I see this invention and still be eligible for all their medical services but in those cases there would be a deductible people at the New do require medical services but can't them selves pay for what should they should they make an application. At the office and then wait for it to be processed to see whether they have been through level job or. The simple way to go about yes as a matter of fact they should not wait until they're to apply Incidentally we are now pre-registering so that any family or any person who feels that he is eligible should apply now and have is eligible to determine. And so densely if he has health insurance he would be expected to make use of his health insurance and meeting it. I think we should be protecting proud of our New York state program I think it's been the best in the country it's not the best. Of my understanding that the. Coverage has been outstanding in progress in the study. Several serious question time raised in Washington and there seems to be very an apprehension. That something may happen to reduce the standards of eligibility. You have any speculation Tom And on that potential Well I realize or has been some apprehension strictly outside New York City most of it I think arises from the fact that people abstained and outside the city do not appreciate our particular problems in New York City you cannot really compare the problems and in urban area where the problems faced in other counties and vice versa I'm not at all disturbed about. The security of the program the program the sound both in terms of social philosophy as well as in terms of financing and I I think the misunderstanding has been unfortunate and I hope during the campaign and after the campaign and the program gets under way that people will understand the program and we will have more right spread support for art I can't concede at this point in time right doing one thing for the aged and not doing as much for the other categories of the population that are equally as disadvantaged. And Brown with the property. They fool not the program services Medicaid program services is in fact enough now people are receiving treatment services Well everybody who has applied for a needed treatment has received treatment. Now the it's only since last week that we've been able to pre enroll people so that they could use the full range of private doctors in the community if they wanted to we're set up and moving the program in its final form in the terms of the way people receive service is not yet in full operation All right Chad right after Brown and just said they must appreciate the fact that program this magnitude in a city as great is now your with all the complexity of the health service industry here is going to have to be staged and we are going to have to do one thing first and the next take the next step second and so forth and so on and I'm not disturbed by the fact that it's going to take us maybe a year or maybe two years had to get the program to where you want to be but we do have to appreciate the stage and I'm going to work out and we're all going to pitch in and try to write those tanks out and make the program a shining example again tire country I think that's an important point to Baca because there has been a good deal of criticism about the beginning of our program you remember that the federal Medicare program when they that was enacted the Social Security Administration the year in which to plan for that program which is nowhere near as complex as the Medicaid program while here with our Medicaid program it was enacted one day and put into effect the next so that we really haven't had the lead time necessary to prepare all the things we would have wanted to but I but we're on the way now and Incidentally it might be important to mention here for the benefit of doctors and other providers of service that any patient who comes into the doctor's office with a Medicaid card or welfare department identification card may receive services and the doctor needn't worry about whether he will be paid as long as the patient has a card. That is a qualification is it not Dr Horton that. The patient who feels that the isn't titled Medicare but has not writers and has not received other than a fixation car what happens to him when he applies for service to his physician and prized possession the physician cannot assume that this patient is eligible because since the law is written in a way that includes the doctor by pass the wrote to the patient that's right or he can provide care to the patient but we cannot guarantee that that patient will be eligible unless the patient has a card the doctor is running the risk of having to look to the patient for his Remember understand it the way he gets the cars still run an application form is a person and a member of a family eligible can appear that advocation isn't forwarded somewhere presumptively to the Department of Welfare and on the basis of those attested fact the card is or isn't That's right how long approximately at present would an applicant have to wait to receive like card back if he were eligible That would depend on what he brought with him when he came to the center if he brings proof of his income for the past eight weeks his eligibility can be determined right on the spot approximately what the general would constitute proof of the. Check stubs from his paychecks or a letter from his employer. Either one. Were also incidentally the welfare Department's taking applications by mail. I think that's an important point destruction that I have seen much stress twenty one. Applications. Letters applications or applications being received but they can mail in applications yes and then after the application has been mailed. Back grappa cation Len ten again come to the welfare to point us for registration and then the registration cards and finally our service that is dependent on physician really a registration card indicating eligibility I know there are exceptions so that people have been. Taken in emergencies on intake at various hospitals and service during a period when their social service departments have been attempting to simultaneously discover if they were qualified for Medicaid. No one so far as I know has been turned away. From receiving service by any hospital municipal or otherwise. Merely because they say. To have this is the situation municipal hospitals and their outpatient clinics don't apply a means test anyway so that whether the patient were eligible or not would not be a condition of his even care that's really a fiscal problem for the hospital so that the patient would receive care and in a support hospital whether he had a car but at the time when he came to the miniscule hospital his application would be taken to determine his eligibility so that a car could be issued. Record you have any comment or question on the suction while I'm literally plays that you know York State and York City but founding the state health department and the City Health Department taking leadership in assuring quality of character reception center this new program and by setting standards they're going making a big step forward in raising the quality of care for all of our people I think that's a proper thing they should be doing resets standards for all the services they purchase in our city in our states and this program is no exception I would like at this time Jim to underscore the fact that you and Mark aground are stressing the fact that under the title my team program we want to get away from the Oprah law concept of the term eligibility that we're thinking in terms of maximum dignity and respect for the human being and all of us regardless of our income at some point in life can become medically needy depending upon elms we unfortunately do not select our own this time by time by price tag as we do a sort of close so regardless of our income and rigorous amount of health insurance we may have privately at some point we're medically needy when we have catastrophic illness and many of us will fall back on this program before we before we die and I think it's a tremendous sense of security that we have that. This is Project action for all of us regarding of our income status and I'm a check any place that we are living in New York City two airmen go semi-private private patient with patient who ordinarily has fallen back on track supported funds for most of his care and in this way we're going to get any rationing our public and private systems which will be entirely practical and we'll end up with one class of health care for all of our people this is an extremely important point that. Areas mentioned so often Medicaid has been discussed in terms of money payments and actually you see in the sense of the quality of dignity or the right of each individual to participate. Someone on his terms it sets a new stage for the provision of all health services in New York City. Particularly in terms of our municipal system and our Health Department facilities director should. Know in this. Need suffer irretrievable financial disaster because of them not only that. But if they are forced. To seek health services and do not have their own personal resources that they will not have to trade their human dignity to get them through socially supported sources and that there is a separation between the total dependent might be said to be represented by those at least temporarily on the city welfare rolls who are automatically covered and the individual. I or others like me. Who may face an incident of the far beyond much of a real New York City committed to the idea that we have the technology and we have as the other things that are needed to abolish the concept of poverty there's no place for poverty and present day society there's no place for Pull all medical care and present day society and I think we've got to find ways as we are doing under Title nineteen to erase the line demarcation between those who can pay for care and those who cannot pay for care out of pocket at a time of illness are moving in the direction of abolishing the charity entrance to the hospital where we're moving in the direction of abolishing poverty and moving the direction of having one coordinated city right system of health services in which we are any grading as Jim is so well said so many times and Dr Brown has pointed out for any grading our preventive services our diagnostic services are a rehabilitation services and cheery services in the one well integrated organized system and I hope that we can take the time and not hurry too fast and can develop this program in stages necessary and build soundly in the direction that we know we have to go in order to have the kind of program that the people want and we want the people to have less far as it appeared that. We actually had the capacity. To render the services now I believe so. Yes I think that much of the apprehension that has been extant has been because people assume that everybody eligible for this program is going to come rushing in to seek it you will recall that at some point there was considerable. Fear about Medicare and the fact that hospitals are going to be overrun with people who. Over sixty five underly first of course this is not materialized in New York state under a previously existing program six million people in the state were always eligible for care and never in any year did we provide care to more than a million and a half now that approximately eight million are eligible perhaps about twenty five percent again will seek to care for them or not everyone in the state is going to is going to become ill in the same year at the same time so I think that these years are really exaggerated our medical services and capacities However expanding at a really that should make it possible for us over the foreseeable future the next year or two years to absorb this load as it does increase let me say that there are two areas in this I'd like to because I think we need. Within our hospitals a both a voluntary and city a substantial building program not because we don't have enough beds. We have enough to do that because they need to be modernized Now we certainly have a shortage of chronic care or nursing home facilities and in my judgment many of the. Facilities that are now used for this are not adequate broad humans and neither do we have an adequate supply of people who love nurses and. Rules are really problems and serious ones that we have faced for a long time because these problems are not created by Medicaid not these problems I made Give me an interesting example that there's been considerable discussion of the nursing shortage in the city hospitals and deed it is a serious problem it's interesting to note the same we've had the same number of nurses for the last decade and it's just that now society is concerned about. The all become concerned about. One of those that one of great things about the new Medicare program. Title eighteen and nineteen is that we're going to have more public information and more ventilation the problems that the health field is facing and I think this is all good I think the only public dialogue that we can have on the gaps in inefficiencies and the things we have to do to build a stronger system I think we should welcome this because we need to have public understanding and the public behind us to make the changes that we all know need doing and they can't do unless they do have the public with us in the interest of clearing up one more recent. Flurry of public misunderstanding. Perhaps you could tell us a little more about. The problem of receiving federal funding which in part underwrite this program that a good deal of public. Over the front that we're rooting. For the federal money buys. This really true this is not true. You may have seen in one of the local papers a few days ago that we're losing twenty million dollars So that's one thing I have referenced as well the fact is that the particular program referred to in that article pays for services for a whole year. There was twenty. Dollars Now the fact is that the program became effective some three months ago so at the worst we could have lost a quarter about amount but the fact is that even that is not a loss since it is possible for us to identify those people who come into our hospitals for care and try to find the care they have received before that and the law does provide that we can go back ninety days in claiming reimbursement so that the figure is very very much exaggerated rest. Time for applications to pile up. And to begin to build a backlog. For the future. In the first four days of the program the registration program began last week there were some eight thousand applications taken now not all of those people will be completely eligible some will have to duck boats others will have health insurance that they must use that only a fraction of those who applied will actually be eligible and not all of the Secret Service not all of those will be Ehlers sick services even this year those three registration applications. The number of registration applicants seem to be growing cost of labor remaining about stable or is sorry to say during the first week our applications have been about as much as we expected so it really is a thing for the individual the suspect she may be eligible for Medicare. Would be to go in person to run the city welfare shoppers scattered around the need for her to write directly to the Department of Welfare for an application that's right and then upon receipt of a new that if occasion card how often this. How long is this card good for for that after the card that the patient receives the applicant receives now will be good on till the end of this year because a doctor bills are applied annually will be automatically replaced or what a new application a new application will have to be made because a determination will have to be made particularly in those cases that have to pay the doctor or the patient the family or the person will have to establish that he has spent the deductible each year in order to become a reality before the next year but that application again can be made in advance Yes and should be made in that job and I'm sorry our time is running out you have been listening to a discussion for the so the stance on Medicaid by the people who know most about Dr Howard J. Brown and Root is the city's health services of the stranger. Mr Harry gray back early executive secretary of the Committee on special studies of the New York Academy of Medicine and Dr James jihad in the first deputy health services administrator. You have been sitting in on a discussion on Section nineteen Medicaid in New York City your moderator has been Ted old factory editor the better time join us next week it is time for another program in Community Action topic next week we'll be Trailways on stepping out of this program directed by Jews side.