Senate Bill S9169

                                 
BILL NUMBER: S9169

SPONSOR: CLEARE
 
TITLE OF BILL:

An act to establish the managed long term care high acuity stabilization
pool; and making an appropriation therefor

 
PURPOSE OR GENERAL IDEA OF BILL:

To establish a targeted, time-limited Managed Long Term Care (MLTC) High
Acuity Stabilization Pool to protect access to care for New Yorkers with
the most complex long-term care needs and to prevent disruption to high-
performing MLTC plans serving disproportionately high-acuity popu-
lations.

 
SUMMARY OF PROVISIONS:

Section 1: Establishes within the Department of Health a $50,000,000
Managed Long Term Care High Acuity Stabilization Pool for SFY 2027,
providing targeted, transitional supplemental payments to eligible high-
quality MLTC plans with disproportionate high-acuity utilization. Eligi-
              

bility is limited to plans with medical loss ratio (MLR) above a commis-
sioner-set threshold not to exceed 92 percent after final premium rates
and risk adjustment. Payments are capped to the amount needed to offset
costs above the threshold. Authorizes DOH to set methodologies, stand-
ards, and reporting requirements. Payments are not incorporated into
base premium rates, and unspent funds revert to the state's general
fund. No entitlement to payment is created.

Section 2: Appropriates $50,000,000 immediately from the general fund to
DOH for the pool, payable on audit and warrant on vouchers approved by
the commissioner.

Section 3: Establishes the immediate effective date.

 
JUSTIFICATION:

Managed Long Term Care (MLTC) plans are essential to helping older
adults, people with disabilities, and medically complex New Yorkers
remain safely in their homes and communities. A small number of high-
performing MLTC plans serve a disproportionate share of members with
complex care needs, high service utilization, and limited alternatives-
particularly in rural and upstate regions.

Recent MLTC rate setting decisions during the transition to the State-
wide Fiscal Intermediary (SFI) have unintentionally destabilized these
plans. Rate assumptions failed to reflect a rapid and sustained shift in
utilization from lower-cost CDPAP services to significantly higher-cost
Licensed Home Care Services Agencies (LHCSAs), while other rate and risk
adjustment decisions shifted funding away from plans serving higher-acu-
ity populations. As a result, several high-quality, high acuity MLTC
plans are now operating above actuarially sound Medical Loss Ratios.

Absent intervention, this instability risks service reductions, care
disruption, or market exits affecting tens of thousands of high-need New
Yorkers who rely on intensive care coordination to avoid hospitalization
or institutional placement. It also limits the ability of high-acuity
MLTC plans to pay quality home care providers appropriately, undermining
workforce stability at a time when the State is investing heavily in
strengthening home care wages, recruitment, and retention.

This bill establishes a targeted, time-limited Managed Long Term Care
High Acuity Stabilization Pool to address this immediate risk while
longer-term rate corrections are implemented. The pool is narrowly
focused on high-quality plans serving disproportionately high-acuity
members, capped at sustainability thresholds, and structured as a Medi-
caid expenditure eligible for federal financial participation.

It is a fiscally responsible, transitional measure designed to protect
vulnerable New Yorkers, preserve continuity of care, support a stable
home care workforce, and prevent far greater downstream Medicaid costs.e
need a full accounting of the status quo.

 
LEGISLATIVE HISTORY:

New Bill, 2026.

 
FISCAL IMPLICATIONS:

50 Million.

 
EFFECTIVE DATE:
Immediate.