The 2011-12 New York State budget has made significant changes to home care and other services for people with disabilities.
The budget, which was passed on March 31, incorporated changes proposed by the state-appointed Medicaid Redesign Team over the last few months, which are expected to save the state $2.8 billion.
The budget calls for mandatory enrollment in Managed Long Term Care programs with the State Department of Health for people over the age of 21 who require home or community-based services, including Consumer-Directed Personal Assistance Program (CDPAP) services. This diminishes the role of local districts in determining a person’s long-term care needs.
However, this change requires a federal waiver that is likely to take until the end of the year to obtain. When the governor announced his initial proposal to alter the program, the Senate added a consumer protection provision calling for a delay of one year prior to implementation.
The budget will limit level 1 personal care services – which include housework, shopping and cooking – to eight hours per week. It has also reduced funding for the Elderly Pharmaceutical Insurance Coverage (EPIC) by $36 million. The approximately 300,000 people who receive EPIC coverage in New York will lose co-pay assistance and Medicare D deductibles.
Joanne Cunningham, head of the Home Care Association of New York State, said the budget will be catastrophic for the state’s home care system.
“It will bring ruin to longstanding home care programs, allows unprecedented government intrusion into home care business operations on a scale unknown to any other area of health care, and it aims a half-billion dollars in unsustainable cuts at an already financially fragile home care service delivery system that is, ironically, saving hundreds of millions of Medicaid dollars to begin with,” Cunningham said.
“Entire home care programs under this budget face categorical extinction despite their proven success in saving millions of Medicaid dollars and despite the fact that the governor's alternatives show no evidence of cost-savings or patient benefit,” she added.
The new restriction in home care hours for level 1 services and the mandatory enrollment in managed care programs with the state could increase nursing home admissions.
State Assembly Health Committee Chair Richard Gottfried and Assemblyman Sheldon Silver released a statement saying that the changes will protect and improve the quality and accessibility of health care while controlling costs.
“Building on the state's successful experience over the past decade with Medicaid managed care, savings will be realized by gradually moving the most high-cost patient groups from fee-for-service Medicaid into various forms of care management - groups such as the elderly receiving nursing home or home care services, and people with serious mental illness,” the statement said.
“The Assembly made sure important consumer protections in these and other areas were added.”
The Assembly Budget Committee held a Medicaid roundtable discussion April 5, which was followed by a Medicaid budget hearing of the Departments of Human Services’ and Health and Senior Services.
The committee focused its discussion on concerns about changes that will add co-pays for Medicare Part D, and on two new provisions of the Affordable Care Act. Those provisions are the Community First Choice Option, which allows states to provide Medicaid home and community-based attendant services, and the Balancing Incentive Payment Program, which offers incentives for states to expand their home and community-based services.
This article was published in the May 2011 issue of Able News.