State lawmakers are eager for a legislative public hearing set for later this month to determine the greatest needs within New York's health care sector and how to strengthen its lacking workforce in the next budget.

A legislative public hearing is scheduled to take place Dec. 19 in New York City for health care workers, providers and stakeholders from across the state to submit testimony to lawmakers about what they need most, Assembly Health Committee chair Amy Paulin said Wednesday.

The issues to be explored, including staffing, making health care less expensive, new education programs and others, will help lawmakers identify health care priorities for 2024 — especially with a projected $4.3 billion budget gap.

"We're hoping to understand and learn so that we can put forward legislative changes, regulatory changes, that could address the workforce shortage without spending additional dollars," Paulin said. "...We have to see what the deficit looks like, and we have to see what the governor proposes."

Lawmakers have started to feel the pressure to address New York's health care workforce shortfall as state leaders discuss ideas to set the tone for the next budget, but say it may not be a problem that can be solved by legislation alone.

Senate Health Committee chair Gustavo Rivera has traveled to hospitals and medical facilities across the state for the last several months to speak with providers and his legislative colleagues about health care issues to work on next year.

The senator says tackling the workforce shortage will require a balance of administrative and executive proposals over time.

"My goal, certainly over the last couple of months and certainly leading up to our next session, is to make sure that we're prepared to have a series of policy choices before us because it's a crisis that's not going to go away," Rivera said.

Employment at nursing care facilities and nursing and residential care facilities decreased across all occupations from 243,740 in 2019 to 210,520 in 2022, or a 13.6% decrease, according to DOH. More specifically, licensed practical nurses decreased by 29.1% and registered nurses decreased 14.8% over the same period.

Meanwhile, home health and personal care aides increased from 420,610 in 2019 to 484,420 in 2022, or a 15.2% increase.

The last budget included $20 billion investment over several years to address health care and staffing.

Rivera visited hospitals in New York City, the Southern Tier and Western New York, and says policy changes will impact health care facilities differently depending on where they are in the state. 

The state's minimum staffing standards in nursing homes and direct resident-care spending regulations took effect Dec. 7, 2022, but the department has not issued fines to facilities to date.

"Fines for staffing requirement violations are being assessed and will be referred for enforcement within the next few weeks," DOH said in a statement Wednesday.

This past session, lawmakers and advocates discussed ways to help people transition to a career in health care, to reduce their student debt, streamline licensing and raise wages. 

State Health Department Commissioner Dr. James McDonald is focused on attracting more nurses to the state, and says hospitals have struggled to recruit physicians and other specialists.

He says lawmakers should explore entering the multi-state Nurse Licensure Compact, which has been done in 41 other U.S. states. Gov. Kathy Hochul and other health leaders have exercised caution with the idea, saying they are concerned it would undermine New York's standards of care.

"I think we need to look at what are strategies other states have done that have been successful," McDonald told Capital Tonight. "I think this is where looking at licensure compacts... would be something that'd be wise for the state to look at next year. 

"You know, can we revisit these ideas and see what makes sense for us?" he added.

The state has spent over $1.8 billion on health care worker bonuses for over 706,000 unique individuals, according to DOH.

McDonald cast doubt the state would extend its $3,000 bonuses for health care workers intended to recruit and retain more staff — a benefit federal dollars could not be used for.

Paulin said she also wants to explore changing the scope of practice for physician assistants, dental hygienists, medical technicians and others to help fill the gaps in services. 

But with limited cash to spend this year, Bill Hammond, senior fellow for health policy with right-leaning think tank the Empire Center for Public Policy, says the budget is likely to include changes to Medicaid — one of the state's largest expenditures in its $229 billion budget.

New York's Medicaid spending has increased 36% since 2019.

"They can't just let it grow at the rate it's growing now, forever," Hammond said Wednesday.

Hammond said New York's Medicaid spending has skyrocketed under Hochul’s watch, attributing it to Hochul's decision to eliminate the global Medicaid cap and simultaneously not including proposals for cost control.

"We have a big expensive Medicaid system compared to other states, but compared to private insurance, as in everywhere across the country, Medicaid is pays relatively little," he said. "So there's room for discussion about how that can be changed."

He's urging policymakers to increase Medicaid payouts where the program is the dominant payer, like in nursing homes.

"You can't really talk about a big increase in Medicaid fees without talking about reforms that would kind of rein in the overall size and cost of the program," he added.

Hochul's office referred questions to the state Health Department and Budget Division.

“New York state remains dedicated to safeguarding the well-being of New Yorkers in both hospitals and nursing homes throughout the state," Division of the Budget spokesman Tim Ruffinen said in a statement. "Additionally, efforts are underway to strengthen the workforce responsible for the care of our most vulnerable citizens. This year’s enacted State budget incorporates a substantial $22 billion multi-year commitment to reinforce the State’s healthcare system, building upon the significant investments made last year. Notably, this includes a 7.5% rise in Medicaid reimbursement rates for inpatient hospital services, a corresponding increase for nursing homes, and a 6.5% boost for outpatient hospital services and assisted living providers.”

A Siena Poll at the end of November showed nearly 60% of New York voters support Paulin's Medical Aid in Dying Act, which would legalize allowing terminally ill people with six months to live or fewer to be prescribed medication to enable them to end their lives.

The assemblywoman says she'll focus on getting the bill over the finish line when lawmakers return to Albany.