Race to the bottom: NLDAC and NY State both aim to be payers of last resort for reimbursing kidney donors

A tale of bureaucracy, in two acts 

1.  NLDAC, the federally funded National Living Donor Assistance Center, was for a long time the only organization that would reimburse  some expenses of living organ donors who qualified by not having high incomes, or any other sources for reimbursements.  That is NLDAC is a funder of last resort:

" Individuals considering becoming a living organ donor can apply for help with their travel expenses, lost wages, and dependent care expenses from NLDAC if they cannot be reimbursed for these costs by their recipient, a state program, or an insurance company.

2. In (very) late 2022,  New York State's Living Donor Support Act (LDSA, S. 1594) became law, and it is about to go into effect this year. The Act provides "state reimbursement to living organ donors, who are state residents, for medical and associated expenses incurred as a result of the organ donation, when the organ donation is made to another resident of the state" 

It further defines NY State as a payer of last resort:, and explicitly rules out payments to donors eligible for payment by NLDAC.

" THE  PROGRAM  SHALL  NOT  PAY  REIMBURSEMENT FOR EXPENSES PAID OR  REQUIRED TO BE PAID FOR BY ANY THIRD-PARTY  PAYER,  INCLUDING  WAGES  OR  OTHER  EXPENSES THAT WERE COVERED UNDER PAID MEDICAL LEAVE BY THE LIVING  DONOR'S EMPLOYER OR THAT ARE COVERED BY OTHER SOURCES  OF  REIMBURSEMENT  SUCH  AS  THE  FEDERAL  NATIONAL  LIVING  DONOR  ASSISTANCE PROGRAM. THE  PROGRAM SHALL BE THE PAYER OF LAST RESORT WITH RESPECT  TO  ANY  BENEFIT  UNDER THE PROGRAM. " 

 

I'm on NLDAC's mailing list, and  a few days ago received an email containing their policy statement on the NY State law. They say they will no longer make payments to NY residents who are covered by the NY State law.

 

 

 

Incidentally, here's my blog post from when the NY State law was passed:

Sunday, January 1, 2023 New York State's Living Donor Support Act (LDSA, S. 1594) was signed by Governor Hochul on Dec. 29

 "like the authorization for NLDAC,  the NY State law (https://www.nysenate.gov/legislation/bills/2021/S1594) "requires that the Program shall be payer of last resort..." I hope that this doesn't turn into a competition to be the payer of last resort in a way that might cause some NY donors to fall between the cracks, and not be reimbursed either by NLDAC or the State of New York."

 

I suppose the larger lesson is that designers of competing markets can create paradoxical situations. 

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Related:

Sunday, July 16, 2023  National Living Donor Assistance Center (NLDAC): I rotate off the advisory board