Situation Report | June 14, 2021
HCA continues to advocate for broad-based home and community-based services (HCBS) infrastructure supports through a major new infusion of enhanced federal Medicaid HCBS funds.
The $1.6 billion in additional funds to New York are from the American Rescue Plan Act and its enhanced Federal Medicaid Assistance Percentage (FMAP) allocations to states. The state Department of Health has indicated that these funds, through the matching process, could actually grow to as much as $4 billion over a multi-year period.
While these funds were appropriated in the 2021-22 state budget, decisions about their precise targets and distribution methods were deferred until after the budget.
Last week, HCA President Al Cardillo wrote to the state’s point person on the initiative to further outline and specify our priority recommendations for the funds, following a May 26 meeting in which HCA and the Department of Health exchanged broad priorities.
“The home care system’s needs in basic workforce support and service operations are so profound that we urge that funds be concentrated for these purposes,” Cardillo wrote in a June 7 letter to Brett Friedman, Director of Strategic Initiatives and Special Medicaid Counsel at the state Department of Health.
Cardillo specifically cites the urgent and growing shortage of workers relative to need that has been enlarged by COVID-19. At the same time, aide training programs have faced major enrollment constraints that HCA seeks to address by urging the state to free up its authorization of hybrid training programs that allow for online components.
HCA’s recommendations for the FMAP funds span a wide range, from direct provider funding supports for worker compensation to infrastructure and provider operations.
On worker supports, Cardillo specifically recommends increases in compensation and benefits under a sustainable reimbursement model for providers beyond the FMAP period, hiring incentives and bonus opportunities, non-wage supports such as daycare or transportation, student loan forgiveness and flexibility in staffing regulations, among other areas.
He also calls for an inter-agency competitive labor market analysis to determine salary and benefit levels — along with commensurate reimbursement levels — truly necessary to address workforce needs, as HCA has recommended in legislation for years.
Cardillo also recommends using funds for aide training programs and the streamlining of virtual hybrid models, as well as telehealth service support and direct financial relief for: COVID-19-precipitated losses; new and ongoing Personal Protective Equipment (PPE); COVID-19 testing requirements; and restoration of agency operation.
The funds should also be used to address home care rate updates that are already required by statute, Cardillo added, noting that six years have lapsed since the state last rebased the Certified Home Health Agency rates, even though the statute requires it at least every three years, causing providers to be “reimbursed substantially below margins” not only in Medicaid fee-for-service but by other payors who use Medicaid as a benchmark for rate negotiation.
The letter also recommends general allocation methods for the funds, including direct funding to organizations and a pooling mechanism.
This new funding investment promises to offer major support for a system with urgent needs across multiple domains, from workforce to operations, and HCA will continue to urge our recommendations in discussions with state officials.