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State Department of Health Posts HCBS Funding Recommendations to CMS

The state Department of Health (DOH) posted its Initial New York State Spending Plan to the U.S. Centers for Medicare and Medicaid Services (CMS) related to the additional federal funds New York will receive for home and community-based services (HCBS) under the federal American Rescue Plan Act (ARPA).

The $1.6 billion in funds were appropriated in the 2021-22 state budget. The Cuomo Administration has spent the last several months considering precise target areas and distribution methods. HCA has learned that these funds, along with the corresponding federal match, is expected to grow to nearly $5 billion.

The DOH spending plan is available here. It has been made available on a new DOH website that will specifically house updates and information related to the ARPA and the state’s spending plan.

Overview of the Spending Plan

The DOH spending plan would fund 43 proposals across three categories:

  • Supporting and Strengthening the Direct Care Workforce.
  • Building HCBS Capacity through Innovations and Systems Transformation.
  • Investing in Digital Infrastructure.

DOH also proposes the following efforts: 

  • Increase the capacity and quality of the HCBS workforce, such that both this workforce, and the Licensed Home Care Services Agencies (LHCSAs) or consumers working in conjunction with Fiscal Intermediaries (FIs), are able to implement evidence-based care interventions, promote quality, and participate effectively in value-based payment (VBP) arrangements, including Mainstream Managed Care Plans and Managed Long Term Care (MLTC) Plans.
  • Strengthen and support existing Fee-for- Service (FFS) and managed care programs that offer Personal Care Services and Consumer Directed Personal Assistance Services  through March 31, 2022 by ensuring adequate program funding is available to support growth in these programs created by related investments that expand capacity and access, including workforce development.
  • Provide worker transportation grants to eligible home care agencies that apply to the state to address identified barriers to worker recruitment or retention based on limited transportation options.
  • Invest $10M on a one-time basis in state and federal enhanced matching funds to supplement FFS Medicaid private duty nursing (PDN) rates for adult recipients to align with the rates recently enhanced for the under 23 population.
  • Expand capacity in Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs by modifying and augmenting existing services and implementing a series of enhancements to support the recruitment and retention of key staff.
  • Invest $40M in state Funds Equivalent as part of capitated premiums paid to PACE Organizations to reopen safely and institute effective infection control measures and provide  workforce development funds for the recruitment and retention of qualified staff to serve as part of members’ Interdisciplinary Teams.
  • Use a directed payment template with MLTCs to fund Adult Day Health Centers (ADHCs) and Social Adult Day Centers (SADCs) based on utilization of services to assist SADCs and ADHCs to reopen safely and institute effective infection control measures and to provide workforce development funds.
  • Conduct a study to develop new Consumer Directed Personal Assistance Program Care Technology.

Advocacy and Next Steps

Since April, HCA has spoken to DOH staff, Administration officials, and state and federal lawmakers about how these funds should be distributed.

In early June, HCA sent a letter to Administration officials with the Association’s recommendations. HCA’s recommendations for the FMAP funds span a wide range, from direct provider funding supports for worker compensation to infrastructure and provider operations.

Public Policy staff are currently reviewing the spending plan to determine which of the Association’s suggestions are included and what else must be addressed. HCA also encourages members to review the spending plan and provide feedback to HCA Public Policy staff.

For questions or concerns about the state’s spending plan, please contact Andrew Koski or Alyssa Lovelace.