Negotiations for the final state FY23 budget are now in full swing. The state senate and the state assembly have released their own “one house” budget proposals and the governor and legislature are in final discussions to finalize a budget by the April 1st deadline.

Below is an update on the status of NYSNA’s priorities and a brief analysis of the latest developments in the budget discussions.

1.    Address Healthcare Disparities: Hospital and Healthcare Funding

• The governor proposes to significantly raise the state Medicaid cap, while the assembly and senate propose to completely repeal the state spending cap. NYSNA continues to support full repeal, but we note that whichever proposal is finally adopted, there will be a significant increase in state Medicaid spending authority.
• The governor, assembly, and senate all propose rescinding the prior 1.5% Medicaid reimbursement cut and adding a 1% across-the-board increase, which will help nursing homes and hospitals. NYSNA still supports higher reimbursement increases and supports increasing rates for psychiatric and other low reimbursement services within the Medicaid program.
• The senate is proposing $1 billion in new safety-net funding and the assembly is proposing $750 million for private-sector hospitals and $250 million for public safety-net hospitals. All sides recognize and are committed to addressing safety-net hospital funding, and we expect a substantial increase in funding in the final budget. NYSNA is also pushing to make sure funding targets hospitals with the highest rates of Medicaid and uninsured patients and that funding is also tied to improving direct care staffing and building a stable, permanent workforce.

2. Expand the RN Workforce: Recruitment, Retention, and Improved Working Conditions

• The governor’s “Healthcare Workforce Bonuses” proposal to encourage retention of direct care staff and acknowledge the dedication of workers during the pandemic has been amended, raising the salary eligibility level to $125,000 per year and fixing the definition of a full-time workweek to 35 hours or more. The assembly has largely eliminated the bonus proposal by limiting it to state workers only and shifting funding to raise healthcare worker salaries. The senate version includes the higher salary cap and workweek corrections and expands coverage to include hospital support services staff. NYSNA continues to advocate for the inclusion of bonus payments in the budget. We also support the proposals in the senate and assembly bills to increase homecare pay rates.
• The “Nurses Across New York” loan forgiveness program is in the senate and assembly proposals, with the senate increasing funding levels in the governor’s proposal to $4.3 million a year. NYSNA will continue to advocate for additional funding and an expansion of nursing workforce support for recruitment and retention.
• NYSNA is also working with other public sector unions in a major push to improve the Tier 6 pension plan to promote recruitment and retention of staff in the public sector, though there is currently no budget proposal to address this. Fixing Tier 6 will remain a priority during the rest of the legislative session if not included in the final budget.
• NYSNA will also continue to advocate to define COVID-19 as an occupational disease for frontline essential workers and to require the New York State Department of Labor (DOL) to set mandatory minimum COVID-19 protections in healthcare settings.

3. Strengthen the Safety Net and Expand Coverage

• All budget proposals include expanding safety-net health services; including loosening Medicaid eligibility and income requirements for seniors and people with disabilities, extending post-partum Medicaid coverage for mothers and infants for a full year, expanding Child Heath Plus to mirror Medicaid services, and lowering premiums for the Essential Plan. We expect all of these improvements in coverage to be included in the budget.
• The senate and assembly have proposed to provide more than $400 million in funding to expand the Essential Plan to include currently uninsured immigrant populations. This proposal will significantly reduce the ranks of the uninsured in New York. NYSNA continues to demand passage of the NY Health Act, but strongly supports the senate and assembly proposals to expand coverage as an important interim step forward in the fight for universal healthcare coverage for all.

4. Protect Nursing Practice and Quality of Patient Care

• The status of the various scope of practice and professional oversight proposals in the budget are still in play in the final budget negotiations.
• The governor’s proposal to join the Interstate Nurse Licensure Compact has been removed from the assembly bill but is included in the senate proposal. NYSNA continues to oppose this proposal as a threat to nursing practice standards and state autonomy in setting licensure standards.
• The governor’s proposal to allow nursing aides to administer medications in nursing homes has been omitted from the senate and assembly proposals. NYSNA opposes this proposal.
• The Nurse Practitioner Modernization Act also remains in play. The governor proposes to partially implement the law, but with restrictions that will still require experienced NPs to be supervised by physicians in some settings. The assembly proposes to make the current law permanent, addressing the sunsetting of the law in June 2022, but making no improvements. The senate omits the NPMA language entirely. NYSNA supports enacting the full NPMA and will work to ensure passage in this session if the issue is not addressed in the budget legislation.
• The governor’s proposal to regulate EMS services and expand paramedicine programs is omitted entirely by the assembly but included in the senate budget bill. NYSNA supports the assembly position that this matter should not be included in the budget and should be subject to more transparent debate and input through the regular legislative process.
• The governor’s proposal to transfer oversight and regulation of nursing and other healthcare professions from the Department of Education to the DOH has been removed from the assembly and senate budget bills. NYSNA continues to oppose the governor’s proposal and does not think it is appropriate to include any changes of this magnitude in the budget process.

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