You Win Some, You Lose Some: Hits and Misses in New York’s Budget

David Sandman
4 min readApr 25, 2024


Photo by Ryan Fleischer on Unsplash

New York State passed its $237 billion fiscal year 2025 budget over the weekend, after lengthy negotiations, an eclipse, and an earthquake. Some issues dominated the headlines: housing, public safety, cannabis, mayoral control of New York City schools. On the health side, discussions about Medicaid rate hikes and a potential hospital closure in Brooklyn took up a lot of oxygen. A measure to guarantee continuous public health insurance coverage for children up to age six, and another to eliminate cost-sharing for insulin among New Yorkers in State-regulated health insurance plans, are being celebrated.

Other items that didn’t get as much attention are also worth mentioning. Some are poised to have a big impact on our health system and on the lives and health of New Yorkers. Others fall short. And some were left out entirely.

Here are some of the hits and misses — and mixed bags — in this year’s State budget.

The hits:

  • Protections against medical debt. New York has been a national leader with policies that protect consumers from unfair practices related to medical debt. Last year, New York became only the second state in the nation, after Colorado, to prohibit agencies from including medical debt of any amount on credit reports. The 2025 budget builds on that earlier success: for example, it prohibits hospitals from suing patients with incomes below 400% of the federal poverty level for medical debt. The legislation also expands hospital financial assistance programs and limits the size of monthly payments for medical debt.
  • Support for doulas. Doulas have been shown to improve birth outcomes, especially for people of color. The budget includes a standing order for Medicaid beneficiaries to receive doula services during the prenatal period and up to one-year postpartum, removing the barrier of requiring a clinician referral to receive doula services. It also establishes a grants program to provide support for recruitment and training of community-based doulas, with a focus on bilingual doulas and doulas from historically marginalized communities. One item that did not make it into the final budget was extending doula services to New Yorkers enrolled in the Essential Plan.

A couple of areas saw mixed results:

  • A small victory for telehealth, with a big gap still remaining. New York had authorized several temporary measures to expand and support telehealth access during the COVID-19 pandemic. (A recent brief from Manatt Health goes into more detail on these policies.) The budget extends coverage and payment parity of telehealth with in-person services through 2026. That should help meet patients’ and providers’ desire to continue the use of telehealth as a convenient and flexible approach to care. On the flip side, the budget did not address a gap in payment for telehealth services delivered by community health centers. As it stands, if neither the provider nor the patient is physically on-site at a clinic, health centers effectively see their payment for that visit reduced by about two-thirds. Requiring that the physician or patient be at the clinic undermines the premise and flexibility of telehealth. Behavioral health and substance use disorder clinics both receive full payment for telehealth services; community health centers should be treated the same.
  • Ongoing support for expanded — but not universal — free school meals. Providing free school meals is proven to reduce food insecurity, improve mental and physical health, boost academic performance, and increase educational and economic equity. Last year’s budget greatly expanded and funded free meals for students. Approximately 83% of public-school students across the State can now receive free meals and that will continue. But support still falls short of universal, leaving out more than 320,000 children in nearly 660 schools across New York State. Beyond school meals, we saw some better alignment across a range of anti-hunger programs. But when an estimated 1 in 10 New Yorkers are experiencing food insufficiency, we need to do more.

And one clear miss:

  • A lack of action to expand the role of Medical Assistants. Medical Assistants, or MAs, are members of a primary care team, and they’re one of the fastest-growing segments of the health care workforce. New York lags every other state in making the most of Medical Assistants’ potential. Most notably, we are the only state that does not allow MAs, under the supervision of a clinician, to administer vaccines. Permitting MAs to administer vaccinations increases the number of health care professionals that can protect New Yorkers against disease. It also frees up doctors and nurses to use their time, expertise, and training to meet more complex patient care needs. New York missed a key opportunity by not expanding the role of MAs; we should be a leading state on health, not at the very back of the pack.

The budget provides a roadmap to understand the State’s top priorities, but it isn’t everything, or the only thing. Lawmakers will continue to hammer out policy proposals in the remainder of the legislative session, and some of the gaps we saw in the budget could be addressed. Policymaking and budgeting is about compromise — it’s rare that everyone gets everything they want. But for a moment, let’s celebrate the wins. And then let’s get back to work to do even more.