Amida Care, New York’s largest nonprofit Medicaid Special Needs Health Plan (SNP) designed for New Yorkers affected by HIV, participated in an online town hall event hosted by Save NY’s Safety Net Coalition to discuss how New York State’s proposed Medicaid reform will put patients at risk. Entitled “Enough is Enough,” the town hall’s participants included coalition members, safety net health care providers, and patients who will be directly impacted by a “carve-out” of pharmacy benefits.

New York’s safety net offers essential services, from health care to housing, to New Yorkers with few other options for care. The proposed reform would harm New Yorkers on Medicaid, by changing how recipients access their prescription drugs: having the pharmacy benefit managed by the state, instead of their health plan. It would also drain $250 million from safety net health providers who would no longer be eligible for pharmaceutical company discounts when purchasing drugs for their patients, according to an estimate from the End AIDS NY 2020 coalition.

Studies show that the proposed “carve-out” will disrupt healthcare delivery for thousands of patients, including those who are impacted by HIV, unhoused and hard hit by COVID-19. The Dec. 17 town hall served as a call-to-action for the state to reverse the carve-out in order to continue delivering quality health care to thousands of New Yorkers placed at elevated risk for HIV/AIDS and other chronic illnesses.

“Special Needs Health Plans (SNPs) were created in 2003 to help people living with HIV access new life-extending therapies and reduce unnecessary hospital visits. Moving the pharmacy benefit from Medicaid managed care to fee-for-service will jeopardize the success of SNPs without generating savings,” said Doug Wirth, president and CEO of Amida Care. “The pharmacy counter has become the intersection where all our health care comes together…[I]t’s counterintuitive to fragment the care. Disruption is certain, and the savings are questionable.”

“This seemingly small change will destroy safety net programs, reverse the progress we’ve made toward ending the HIV/AIDS epidemic, send us backwards in our goal of reducing health disparities for people of color and low-income communities, and cause the communities we serve to become sicker,” said Jacqui Kilmer, CEO of Harlem United.

“Each one of these providers has made it very clear to me how they have used this funding, over the years, to serve these vulnerable populations,” said NYS Senator Gustavo Rivera. “They need these resources, and we need to make sure we will stand with them—and I will continue to do so.”

The town hall concluded with a panel discussion led by Anthony Fortenberry, chief nursing officer at Callen-Lorde Community Health Center.

Anthony Randolph, a consumer and board member at Amida Care and Harlem United who participated in the panel discussion, praised both organizations, which will be negatively affected by the carve-out. “When I had trouble filling a prescription that my doctor told me I needed immediately, I called my Harlem United caseworker. While I was sitting in the pharmacy, they called Amida Care, who got in touch with my doctor, who got in touch with the pharmacist. When the pharmacist approached me, I thought he was going to tell me I needed to leave. Instead he said my prescription would be ready in 15 minutes. Under the governor’s plan, I would have to call a 1-800 number with thousands and thousands of other people. By the time they would have resolved my issue, it might have been too late. So I ask the people in power, how much is my life worth to you?” Randolph said.

Momentum is growing against the carve-out. As New York is on the verge of ending the HIV epidemic and working to end the extreme health disparities laid bare by the coronavirus pandemic, a broad coalition is standing up in opposition to disrupting health care for the most vulnerable in the state.

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