What the Federal Stimulus Package Means for New York State Department of Health Programs

Table of Contents

Drinking Water State Revolving Fund (DWSRF)

The Department of Health, in partnership with the Environmental Facilities Corporation (EFC), administers a grant and loan program to improve and rebuild public water supply systems. Municipalities and other organizations which operate public water supply systems are eligible to apply.

New York State received $86.8 million from Stimulus funds. 50% of the money was required to be spent as grants (principal forgiveness), and a minimum of 20% of the funding was dedicated to "green" projects.

What this means for New Yorkers

There is a long list of public water systems that are already waiting for money to fund needed improvements, totaling about $2 billion of projects across New York. This funding enabled more cities, towns, villages and private water companies to upgrade their water systems sooner than would have been possible without the Stimulus funding.

  • DWSRF ARRA national funding: $2 billion available for obligation until 9/30/10
  • NYS share: $86.811 million
    • New York made $81.6 million available for infrastructure improvements. Although allowed to use up to 31%, NYS used only 6% of the total ARRA dollars for program administration.
    • A minimum of 20% of ARRA funds were required for "green" projects. A total of 33%, or $29.4 million, was committed for these types of projects – including $6.1 million that was set aside for the Green Innovation Grant Program, overseen by the Environmental Facilities Corporation.
  • More information about the Drinking Water State Revolving Fund

Early Intervention Program (EIP)

The Early Intervention Program provides speech, hearing, and other therapies to developmentally delayed children from birth to the age of 3. It is run by the Department of Health and local health departments. Services are provided by agencies and individuals in local communities who have been approved by the Department. Over 70,000 children and their families are served by the Early Intervention Program.

New York State's Early Intervention Program received $11.8 million in funding in April and $14.6 million in August, 2009.

What this means for New Yorkers

The added funding will be used to pay for improvements to the information systems and operations of the Early Intervention Program. This will help to better coordinate the services families receive. New York City and counties across the State will have their Early Intervention administration funds increased by a total of $8 million. More information on how ARRA EI funds are being used is found in its expenditure plan (PDF, 111KB, 19pg.).

Health Information Technology (Health IT)

Even before the Federal Government provided the monies in the Recovery Act, the Department established the Office of Health Information Technology Transformation (OHITT), which works with hospitals and practitioners in New York State to switch over to a system of electronic health records.

During 2009, $2 billion of stimulus funding was made available to the National Coordinator for Health Information Technology, to support the implementation and development of electronic health records throughout the country.

What this means for New Yorkers

Since New York State already has OHITT in place, any funding received would be used to support and expand state initiatives.

Nationally, in addition to the $2 billion mentioned above, another $14 billion has been designated for promoting electronic health record-keeping for Medicare and Medicaid patients. This is a longer-term program that is not expected to begin funding until 2011. The amount of money New York would receive is yet to be determined.

National Coordinator for Health Information Technology (ONCHIT)

  • ARRA national funding: $2 billion

In its Program Implementation Plan released in mid-May ONCHIT initially segmented its Recovery funds for the following purposes.

  • Privacy and Security, $24.285 million
  • National Institute of Standards & Technology, $20 million
  • Regional HIT Exchange, $300 million
  • Unspecified, $1,655.715 million

In August 2009, ONCHIT set aside $564 million to be distributed to states or a state-designated organization through cooperative agreements to advance the necessary governance, policies, technical services, business operations and funding mechanisms for health information exchange, building off existing efforts to advance regional and state level towards nationwide interoperability. New York State, through its designated entity the New York eHealth Collaborative, was awarded $22.3 million.

Also in August 2009, ONCHIT announced that certain not-for-profit organizations were eligible to compete for grants for the HIT Extension Program, Regional Centers Cooperative Agreement Program. On November 25, 2009 the original amount announced was increased by $42 million to a national total of $640 million and the award cycle was compressed from three application deadlines to two: preliminary applications for the first round were due September 8, 2009, and for the second, December 22, 2009. New York State, again through the auspices of NYeC, received $26.5 million. New York City, through the Fund for Public Health New York, received a grant of $21.7 million.

Also on November 25, 2009, ONCHIT announced that $70 million would be awarded competitively across the country to public and private institutions of higher education, targeted especially to community colleges, to develop and strengthen training programs for health information technology professionals.

  • Five awards are expected to be made, with a minimum amount of $6.2 million and a maximum of $21.15 million.
  • Applications were due January 22, 2010.

Another $10 million in Recovery funds was set aside by ONCHIT for up to five institutions of higher education to develop materials for these programs: Information Technology Professionals in Health Care: Curriculum Development Centers. Columbia University received an award of $1.82 million on April 2, 2010.

On December 2, 2009, ONCHIT announced a new Beacon Community Cooperative Agreement Program. Awards were made on April 7 to twenty-one states, and to the National Indian Health Board, totaling over $267.6 million. New York State did not receive additional funds from this opportunity, having obtained ARRA funds for our regional extension centers in February 2010.

  • Eligible applicants include state, county, city, township, special district and tribal governments; institutions of higher education and not-for-profit organizations. However, selected communities must already be national leaders in the advancement of health information technology and have advanced rates of electronic health record adoption and health information exchange.
  • ONCHIT expected to make 15 awards, totaling $220 million, with an award ceiling of $20 million and floor of $10 million. On May 4, 2010, the Western New York Clinical Information Exchange, Inc. was awarded over $16 million.
  • $15 million was set aside to provide technical assistance and to evaluate the grant recipients.
  • Applications were due February 1, 2010.

On December 17, 2009, three more HIT training related opportunities were announced, all with applications due January 25, 2010:

  • $6 million was to be awarded to an institution of higher education, or a consortia of colleges and universities, to develop and initially administer a set of health information technology competency examinations. New York State did not receive this grant.
  • As one of nine universities across the country sharing $32 million, Columbia University received almost $3.8 million to expand or create programs leading to a baccalaureate degree, masters degree, or certificate of advanced studies in one or more of the following six targeted roles:
    • clinical / public health leader;
    • health information management and exchange specialist;
    • health information privacy and security specialist;
    • research and development scientist;
    • programmer and software engineer; and
    • health IT subspecialist.
  • $60 million, with a minimum award of $10 million and a maximum of $18 million, was expected to be awarded to approximately four public or private institutions or other organizations with a research mission, to establish Strategic Health IT Advanced Research Projects (SHARP) to focus on where breakthrough advances are needed to address well-documented problems that have impeded adoption of health IT and to accelerate progress towards achieving nationwide meaningful use. New York State did not receive a SHARP grant.

On March 29, 2010, ONCHIT announced that it would supplement the current Regional Extension Center cooperative agreements to ensure the provision of service to Critical Access Hospitals (CAH) and to rural hospitals having fewer than 50 beds. Applications were due April 30, 2010. On September 10, ONCHIT awarded supplements totaling almost $20 million to 46 Centers for two year projects. NYeC received an additional $120,000. On December 28, 2010, ONCHIT announced a second supplement to bring the total available for each CAH and rural hospital to $18,000. Applications were due January 12, 2011, and NYeC received another $60,000 to share with the ten qualifying sites in New York State.

On April 2, 2010, the Agency for Healthcare Research and Quality (AHRQ) awarded over $44.3 million to various contractors across the country for activities to support regional extension centers advance the use of electronic health records and the exchange of medical information between providers. Contracts included funds for:

On May 26, 2010, ONCHIT announced another round of funding for Beacon Communities to build and strengthen their health information technology infrastructure and exchange capabilities to demonstrate the vision of the future where hospitals, clinicians and patients are meaningful users of health IT, and together the community achieves measurable improvements in health care quality, safety, efficiency, and population health.

  • Cooperative agreements, over a 31 month performance period, would be awarded to two qualified non-profit organizations or government entities representing geographic health care communities. Selected communities must already be national leaders in the advancement of health IT, workflow redesign and care coordination, or quality monitoring and feedback. In addition, successful communities must have advanced rates of electronic health record (EHR) adoption and health information exchange (HIE), and the readiness to incorporate health IT to advance community-level care coordination and quality monitoring and feedback.
  • Total funding $30,375,000, with a minimum award of $10 million, maximum of $18 million.
  • Eligible to apply were state, county, city and tribal governments; institutions of higher education; and nonprofit organizations.
  • Letters of intent were due June 9, and applications due June 28, 2010.

On January 27, 2011, ONCHIT announced another round of grants for the HIT Extension Program - Regional Centers:

  • $32 million was awarded nationally - with the Department of Health's designated entity, NYeC, receiving another $404,776, brining its total funding to almost $27 million.
  • NYC Reach also received supplemental funding of $179, 700, brining its total to almost $22 million.

Another round of supplemental funds targeted specifically to accelerate the conversion to electronic health records at critical access hospitals (CAHs) was awarded February 8, 2011. Again the grant to NYeC was increased, by $60,000.

On March 25, 2011, ONCHIT released a draft, revising Federal Health IT Strategic Plan that was legislated as part of ARRA, and originally issued in June 2008. In addition to the Medicare and Medicaid incentive programs for "meaningful use" of electronic health records, new goals incorporated into this draft Plan include:

  • Integrating HIT into the National Health Care Quality Strategy and Plan that is required by the Patient Protection and Affordable Care Act (PPACA);
  • Fostering business models that create and support health information exchange entities;
  • Strengthening data protections to improve privacy and security;
  • Empowering individuals with access in order to move towards more patient-centered care; and
  • Building a "learning health system" to improve the knowledge about health care across populations.

Electronic Health Record (EHR) Technology

  • ARRA national funding: $14 billion

The Recovery Act established an incentive program for payment to eligible professionals and hospitals that adopt and become meaningful users of certified electronic health records. EHRs improve the quality of health care for the citizens of New York and make their care more efficient. The records allow many providers who may be treating a Medicaid patient to coordinate care. Additionally, EHRs make it easier for patients to access the information they need to make decisions about their health care.

The Centers for Medicare & Medicare Services (CMS) launched the official website for the Medicare & Medicaid EHR Incentive Programs. This website provides the most up-to-date, detailed information about the EHR incentive programs including "tip sheets", flowcharts, and presentations on eligibility, certification, "meaningful use," and registration.

The Office of the National Coordinator for Health Information Technology (ONC) issued a final rule to establish the permanent certification program for health information technology. Meaningful use of certified EHR technology is a core requirement for eligible health care providers to receive incentive payments.

The temporary certification program, established in June 2010, will continue in effect until it sunsets on December 31, 2011, or until such time as the processes for permanent certification are completed.

Features of the permanent certification program include:

  • Organizations must first be accredited in order to test and/or certify health information technology;
  • Certification bodies authorized by ONCHIT Authorized Certification Bodies or ONC-ACBs are required to conduct post- certification surveillance; and
  • ONC-ACBs are permitted to perform "gap certification".

The National Institute of Standards and Technology (NIST) through its National Voluntary Laboratory Accreditation Program (NVLAP) must develop a laboratory accreditation program for organizations to be accredited to test health information technology.

CMS has made it easy to determine eligibility for the Medicare and/or Medicare incentives by offering an interactive "wizard".

On July 13, 2009, a regulation issued by the Centers for Medicare & Medicaid Services (CMS), defined the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for the payments. Another rule, issued by the Office of the National Coordinator for Health Information Technology (ONC), identified the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

The Recovery Act provides a 90 percent federal match for state planning activities to administer the incentive payments to Medicaid providers, to ensure their proper payments through audits and to participate in statewide efforts to promote interoperability and meaningful use of EHR technology statewide and, eventually, across the nation.

On December 9, 2009, the Centers for Medicare & Medicaid Services (CMS) announced that New York's Medicaid program received $5.91 million in federal matching funds for state planning activities necessary to implement the electronic health record (EHR) incentive program. The State's Planning Advance Planning Document (PDF, 73KB, 15pg.) describes the steps to be taken to implement incentives, such as:

  • Conduct stakeholder outreach
  • Conduct an "as-is" landscape assessment of HIT / HIE adoption and current initiatives in New York State
  • Develop a 5-year "to-be" vision for HIT / HIE activities in NY Medicaid
  • Develop a roadmap to achieve the NY Medicaid 5-year vision
  • Develop a strategy for implementation of the Medicaid EHR incentive program
  • Finalize a statewide patient-centered NY Medicaid HIT / HIE plan and submit to CMS for approval. The New York State Medicaid Health Information Technology Plan (SMHP) was submitted to CMS; however, it will not become official until CMS renders a formal approval.

On August 17, 2010, CMS distributed guidance to State Medicaid agencies detailing the requirements for administering the electronic health records (EHR) incentive program.

For more information and guidance on meeting meaningful use criteria:

Medicaid Federal Medical Assistance Percentage (FMAP)

Medicaid is a health insurance program for people with limited income or who are elderly or disabled. It is paid for by a combination of federal, state, and local dollars. Until June 30, 2011, the federal government increased its Medicaid contribution by a minimum of 6.2%. States qualified for further adjustments if they had increasing unemployment after October 31, 2008 when compared with the rates from the lowest three consecutive months beginning in 2006. For New York State, the increased federal share is totaled approximately $11.1 billion. This will mean that the state and local governments will contribute a smaller percentage as their shares to fund the costs of Medicaid.

What this means for New Yorkers

These 27 months of additional ARRA federal dollars allowed the State to maintain Medicaid services and eligibility. During this period, the state and counties were able to afford their share of Medicaid costs without increasing taxes or cutting programs. This was true even when more people needed Medicaid because they became unemployed. People who moved from welfare to employment were able to stay on Medicaid for a longer time while waiting for employer-sponsored health insurance to start.

Temporary Increase in Federal Medical Assistance Percentage (FMAP)

Prevention and Wellness Fund

Nationally, Stimulus funding provides $1 billion to the U.S. Department of Health and Human Services. This will be divided into at least three major areas: $300 million for immunizations (mostly for purchase of vaccines); $50 million for infection control and monitoring; and $650 for community programs to prevent chronic disease (such as heart disease, diabetes, high blood pressure, and other illnesses.) The Department of Health and Human Services has until the middle of May to present a detailed plan to Congress on how it intends to direct the spending of this money.

What this means for New Yorkers

The Centers for Disease Control outlined its intent to spend ARRA funds as follows:

  • ARRA national funding: $1 billion
    • $300 million:
      • $32 million to CDC for internal use:
        • To increase national public awareness and knowledge about the risks and benefits of vaccines and vaccine-preventable diseases
        • To provide tools and education for health care providers
          • CDC announced a competitive grant opportunity, open to public and private nonprofit organizations, for immunization cooperative agreement partnerships, total of $2.5 million, with applications due July 6, 2009, for three different purposes:
            • Provide Technical Assistance and Training for Immunization Coalitions and Health Departments
            • Develop and Implement Materials and Programs to Educate Nurses about Immunization Issues
            • Develop Vaccine Safety Communication Materials and Curriculum for Medical Residents
        • To monitor and assess the impact and safety of licensed vaccines
      • To states:
    • $50 million for healthcare acquired infection control and monitoring
      • From CDC: $40 million available to states through competitive grants to create or expand state-based healthcare acquired infection (HAI) prevention and surveillance efforts and to strengthen the public health workforce trained to prevent HAIs. Existing Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) and the Emerging Infections Program (EIP) competitive cooperative agreements will be used to make supplemental competitive awards to State health departments to carry out HAI activities.
      • From CMS: $10 million allocated to states to improve the process and increase the frequency of inspections for ambulatory surgical centers. Payments will be made to States separate from but in the same manner as operation of the Survey and Certification program using Federal Hospital and Supplementary Medical Insurance Trust Funds.

    • $650 million for evidence based clinical and community based prevention strategies
      • $373 million to local communities for the Communities Putting Prevention to Work initiative that will support evidence-based prevention strategies to combat the effects of obesity and tobacco use. CDC announced forty-four awards on March 19, 2010, including one to NYC (the New York City Fund for Public Health in New York, Inc.) for $31.1 million. NYC will receive a supplement to this grant from CDC in order to collect Behavioral Risk Factor Surveillance System data. Over $11 million has been set aside nationally; the amount of NYC's supplement will be determined by CDC through a competitive evaluation of its application and those of the other 29 eligible localities. Applications were due May 14, 2010. In addition, NYC is eligible to submit an application:
      • $277 million to states; so far the following opportunities have been announced:
        • $125 million to States and territories as Supplemental Funding for Healthy communities . Two components were for supplements to existing cooperative agreements which are under the auspices of HRI; New York State received a total of $3.988 million for anti-tobacco and anti- obesity programs. A $3 million competitive grant for statewide initiatives such as promoting and evaluating posting calories on menus and decreasing the consumption by taxing sugar-sweetened beverages was also awarded.
        • As an expansion of the Communities Putting Prevention to Work initiative, $27 million for State Aging and Health Departments, that will identify communities and local organizations to deliver a Chronic Disease Self-Management Program targeting older individuals, including frail seniors, with multiple chronic conditions, in order to reduce health care costs. New York State received $1.19 million , awarded to the State Office of the Aging.
  • On March 5, 2010, the Department of Health and Human Services, Office of Public Health and Science (OPHS) announced a $10 million competitive grant opportunity, Prevention and Wellness - Leveraging National Organizations. OPHS expects to make ten awards to public or non-profit organizations that have an established (two years or longer) national outreach infrastructure with an existing focus on populations-based approaches such as policy, systems, and environmental changes in the areas of obesity, nutrition, physical activity, and/or tobacco.

    Eligible organizations may propose activities in one or both categories:

    1. Obesity prevention through improved nutrition and increase physical activity
    2. Tobacco prevention and control

    Applications were due April 19, 2010 and awards were announced July 7th to the following national organizations: American Academy of Pediatrics; American Heart Association; American Lung Association; Association of American Indian Physicians; BlazeSports America; Community Food Security Coalition; National Association of Latino Elected and Appointed Officials Educational Fund; National Recreation and Parks Association; Sesame Workshop; and Society for Public Health Education.

  • Also on March 5, the Centers for Disease Control announced a new grant opportunity, Laboratory Technical Implementation Assistance for Public Health Cooperative Agreement Program.
    • CDC will make two awards, totaling $2 million, to assist state/territorial/large local public health laboratories and state/local health departments to enhance laboratory information management systems and other critical IT infrastructure to support interoperability of electronic laboratory data between clinical care (through EHRs) and public health agencies.
    • Eligible applicants include nonprofit organizations and for-profit businesses; institutions of higher education; research institutions; hospitals; community-based and faith-based organizations; tribal governments and health corporations; State and local governments or their Bona Fide Agents; and political subdivisions of States (in consultation with States).
    • Letters of intent were due March 12 and applications May 2, 2010.
  • On May 6th and 7th , CDC announced three grant opportunities, all with applications due June 8, 2010:
    • The first is limited to those 58 jurisdictions currently with a cooperative agreement for epidemiology and laboratory capacity (ELC). Both New York State and New York City are eligible to compete for a supplement between $100,000 and $600,000 to enhance and advance infrastructure and interoperability to support public health laboratories in satisfying Stage 1 criteria for meaningful use of health information technology.
    • The second, targets 33 current CDC immunization program grantees for enhanced interoperability of electronic health records with immunization information systems. Only New York City is eligible in NYS. Grants will be between $600,000 and $1.5 million.
    • The third opportunity assists those organizations with healthcare stakeholder membership and a focus on leadership for the optimal use of HIT, creating a Lab Interoperability Cooperative. CDC expects to award $5 million to one or two organizations to ensure that hospital laboratories meet the recently promulgated standards on electronic health records technology and on meaningful use criteria in the Medicare/Medicaid provider incentive program. Competition is open to State, local and tribal governments, non-profit and for profit businesses, hospitals, colleges and universities, research institutions, and community-based and faith-based organizations.
  • On November 24, 2010, CDC announced that $5 million would be available nationwide for lab interoperability cooperatives. Funds will provide services to hospital laboratories to satisfy the Stage 1 HIT "meaningful use" objective to submit electronic data on reportable lab results to public health agencies.
    • CDC expects to make two awards, between $2 million and $5 million.
    • Eligible to apply are: for profit and nonprofit organizations, including small, minority and women-owned businesses; institutions of higher education; hospitals; research facilities; state, local and tribal governments; and community and faith based organizations.
    • Letters of intent due December 8, 2010, with full applications January 8, 2011.
  • More information on how the Department will use its ARRA Immunization funds is found in the program's expenditure plan
  • More information about the Prevention Agenda Toward the Healthiest State
  • More information about Immunization
  • More information about Infection Control


The Supplemental Food Program for Women, Infants, and Children, known as WIC, provides coupons for nutritious food for lower-income pregnant and breastfeeding women, infants, and children up to the age of 5. WIC is run by the Department of Health in partnership with over 100 local agencies, such as county health departments, clinics, and hospitals. Funding for WIC comes from both the state and federal governments.

For New York State, the increase in federal funding for WIC from the stimulus package totals $13.7 million: $5.5 million to meet food costs related to increased WIC caseload, and $5.1 million for miscellaneous technology grants to replace current benefit check printers, to upgrade outdated computers, printers and monitors at numerous locations throughout New York State and to begin conversion to a web-based information system.

What this means for New Yorkers

It's expected that more women and children will become eligible for WIC as more families face unemployment. The increase in federal funding will help cover the costs of food and of administering the program for a larger number of people. ARRA WIC funds were used in June 2009 to pay for food costs for over 106,000 women and children across all counties in New York. Payments tracked with caseload, with almost 60% of funds going to the five boroughs in New York City.

More Information