Advocacy Update

Calibrating to a new presidential administration, a new congress and a new state legislature has kept us busy!

Tariffs and a shift to disruptive economic policies, state progress, and federal challenges have been the hallmark of the early part of the year. Through it all IHA continued its strong focus on advocacy. At the state level we worked hard to secure funding for Upstate healthcare in the FY 2026 budget and defended against destructive cuts on the federal level.

Since January, IHA has been actively engaging with legislators, raising awareness of the significant challenges impacting healthcare in Upstate and rural New York. Key concerns include ever increasing expenses, workforce shortages, pharmaceutical costs and threats to the 340-b program, and funding and financial uncertainty, among others. We have called for increases to supportive funding and multi-year investments. While there is uncertainty and an extreme volatility at the federal level, IHA has stressed to state leaders the urgent need to plan and safeguard our vital health care facilities.

These efforts have made a clear impact, shaping a final FY 2026 budget that reflected meaningful improvements from what we have seen in past years, but there is still more to accomplish. IHA remains dedicated to advocating for fair funding and support for its members. None of this progress would have been possible without the commitment and collaboration of our members. Our collective advocacy matters now more than ever. We look forward to continuing this work with you over the remainder of 2025.

IHA’s advocacy for state fiscal year 2026 began in the fall of 2024. We met with key stakeholders early and often to ensure our message was top of mind. We spoke with the Governor’s office, Budget Director, Health committee chairs from both houses, calling for sustainable investment to stabilize and transform hospitals in Upstate and rural New York.

For further details of the final budget please see the “State Fiscal Year2026 Budget” section below.

In February IHA included key members of IHA’s Executive Committee at its first in-person Albany Advocacy Day in recent memory. We met with leadership and lawmakers including Senate Majority Leader Andrea Stewart-Cousins, the Health chairs from both houses, Senator Gustavo Rivera and Assemblymember Amy Paulin, as well as many members that represent IHA hospitals and key staff members. These meetings provide the valuable opportunity for legislators to hear directly about the opportunities and challenges for health care leaders in Upstate. Our conversations were productive and fruitful. We appreciate all who participated and plan to provide similar opportunities in the future.

Political Landscape

Considering the passage of the reconciliation package in Washington in July, the rift between Governor Hochul and Lt. Governor Delgado and the likelihood of a gubernatorial democratic primary, the probability of Rep. Elise Stefanik running for Governor, and the three way race between Mayor Adams, Governor Cuomo and Assemblymember Mamdani to be the next mayor of New York City, it seems that the political landscape is constantly shifting beneath our feet.

Next year’s midterm elections in House of Representatives will be important to watch especially in the context of delaying implementation of or reversing policies enacted in the reconciliation package. We continue to watch and monitor these contests and the gubernatorial race to react to and adjust our advocacy strategy.

At the Federal level, there is no question that the Trump Administration’s reconciliation bill signed into law, if left intact will have lasting and profound effects on hospitals in Upstate and rural New York measured not in years, but decades or generations.

Implementation steps as yet to be determined by the State, IHA is gravely concerned about the unprecedented impact that this bill will have on hospitals in Upstate and rural New York. Throughout the process we were in contact with our congressional representatives, the State, and our colleagues in the association space representing different segments of the healthcare spectrum. We continue to send the message that the impacts of these policies will have a significant negative impact on the communities our members serve.

Below is one of the statements issued and served as the basis of the many media segments in which I participated to bring your voice into the conversation.

IHA Statement on Proposed Medicaid Cuts

DON’T MESS WITH MEDICAID!

For hospitals in Upstate and rural regions of New York—many of which are the sole providers of healthcare for dozens of miles—the detrimental level of financial pressure that would be wrought by this bill is simply untenable. These Medicaid proposals could lead to reductions in critical services, or even hospital closures. In many cases these facilities also are the major economic drivers in their communities. Effects of this bill would ripple far beyond healthcare, threatening patients’ access to care, and the stability of jobs provided by hospitals and in turn, the economic health of local communities. The House budget reconciliation bill poses an existential threat to New York’s already fragile healthcare infrastructure.

State Fiscal Year 2026 Budget

The budget was passed on Friday, May 9 after twelve budget extenders. The final budget includes much needed funding and longer term financial planning for NYS healthcare. However, many of the investments made in the state budget are dependent upon the Managed Care Organization (MCO) Tax/Assessment which is now being called into question due to the reconciliation package and the rule proposed by CMS to limit such taxing tools. Highlights of the final budget as it was passed include the actions below. Some of these may be limited as a result of the federal reconciliation package:

Medicaid reimbursement rate increase

Up to $425 million to support an estimated 10% increase to Medicaid payment rates for hospital outpatient services, anticipated to continue through March 2028.
Up to $445 million to increase Medicaid payments to nursing homes in SFY 2026, and up to $385 million annually thereafter, anticipated to continue through March 2028.

Safety Net Transformation Program

$1.3 billion in combined capital ($1 billion) and operating ($300,000) support for this program, which was first established in last year’s budget.

Vital Access Provider Assurance Program (VAPAP)

Restores $500 million in proposed cuts to the hospital VAPAP. With this restoration, the budget sustains about $3.25 billion for supportive funding programs for financially distressed safety net hospitals and other providers through VAPAP, the Global Budget Hospital Initiative, Directed Payment Template programs and Vital Access Provider funding programs.

Governor Authority

Authorizes the governor to make mid-year spending cuts if any SFY 2025-2026 quarterly financial update reflects, or at any point during the final quarter of SFY 2025-2026, the state budget director projects a cumulative general fund imbalance of $2 billion or more. Legislators will then have 10 days to accept the proposed cuts or propose equivalent spending cuts that conform to certain requirements of the provision.

End of Session Recap

Due to the significantly delayed budget, this year’s legislative session was compressed into just a few short weeks, creating major challenges in advancing legislative priorities. Despite the time constraints, a total of 16,767 bills were introduced and 856 bills were passed by both houses—51 more than in the 2024 session. This increase came despite having far less time between the budget’s passage and the end of session.

IHA prioritized several key pieces of legislation this session, many of which focused on workforce initiatives. Our number one priority included a stronger version of a bill that would temporarily allow out-of-state nurses to practice while awaiting permanent licensure. This bill was amended by its sponsors to include a three-year work requirement for individuals who would have applied for temporary practice. These amendments significantly diminished the intent to help upstate and rural hospitals attract much needed talent. Ultimately the bill did not have enough momentum to make it over the finish line this session. The original draft of the bill will remain one of our top priorities for the 2026 legislative session.

There were also a number of bills for which we advocated, issuing memos of support or opposition, as appropriate. We will continue our advocacy efforts as the Governor considers legislation.

Bills that passed & await Governor action

S.4906 / A.6055, Victim statements in hospitals (Support)
S.4423 / A.6063, Wrongful Death (Oppose)
S.5294 / A. 203, Violence Prevention Program (Oppose)
S.1226 / A.6004, Local Input in Community Healthcare (LICH) Act (Oppose)

Bills that did not pass

S.2080 / A.6051, Protecting hospitals workers from assault expansion (Support)
S.705 / A.2140, (Un)Fair Pricing Act (Oppose)
S.4641, Non-Compete Agreements (Oppose)
S.335 / A.2015, Anti-Trust (Oppose)

Clinical Staffing Committee Report

In early April the Department of Health released the 2023-2024 Clinical Staffing Annual Report. Highlights of the report are included below:

Regional distribution shows 77% (2,542) of complaints originated from NYC region facilities.
Only 37 complaints (approximately 1%) were related to quality-of-care issues, suggesting that staffing plan technicalities rather than care quality is the primary focus of complaints.
A significant increase in complaint volume with 3,274 staffing complaints submitted during the reporting period (October 1, 2023 – September 30, 2024), representing a substantial increase from the previous reporting year.
81% (2,641) of complaints alleged insufficient clinical staffing as defined by Public Health Law §2805-t.
77% (2,532) of complaints were appropriately submitted to facility Clinical Staffing Committees prior to Department submission.
Union representatives submitted 67% (2,215) of all complaints, with hospital employees accounting for 30% (974).
The Department has resolved 61% (1,992) of complaints, with 1,236 being substantiated.
The NYS Department of Health conducted nine on-site surveys in response to 626 complaints, along with off-site reviews for 2,546 complaints.

These results are not surprising, the main takeaway being that the bulk of complaints are focused on technical aspects, and not patient safety or quality of care.

We thank you for your continued engagement and participation in events like Advocacy Day. The contributions made by our members enhance advocacy efforts and allow IHA to effectively carry the message that hospitals in Upstate and rural New York need more support.

Advocacy Update – Spring/Summer 2025 Newsletter