Legislative Session: HCA Presses Post-Budget Priorities

Capitol Report | April 2021

HCA thanks the Senate and Assembly for restoring what would have been severe Medicaid cuts in this year’s state budget.

We also appreciate your enactment of a dedicated fund for home care workforce support in place of an impossible-to-finance “wage mandate.”

HCA has strongly advocated supports for higher wages and other critical worker needs. The success of this effort requires a sustainable funding structure at its base, which is why HCA has developed legislation to provide such a framework.

Yet much more work needs to be done. HCA looks forward to our continued discussions with your office on these and other post-budget legislative priorities, as outlined below.

Home Care Workforce Funds

The state budget appropriates $1.6 billion in enhanced federal Medicaid funds for workforce, a portion of which would be dedicated to home care workers. This is an exceptional opportunity to make a down payment on a sustainable structure of home care workforce support.

As the statewide association representing the home care system, HCA seeks a principal role in working with the Legislature and Executive to design this initiative. Our proposal, which we urge the Legislature to adopt, would build a financing structure into provider rates, including funds for enhanced wages and other non-wage supports as well as a framework to address workforce shortage regions or disciplines.

Amend the FI RFO, Repeal the LHCSA RFO

A flawed and opaque set of application processes — called a Request-for-Offers (RFO) — was carried out by the Department of Health to decide who can operate as a fiscal intermediary (FI) or Licensed Home Care Services Agency (LHCSA) in New York.

The 2021 state budget amended the RFO for FIs to address some of these flaws; but more changes are needed to avoid the RFO’s exclusion of quality FIs who are effectively serving cases in the state’s Consumer Directed Personal Assistance Program (CDPAP).

Meanwhile, an outcome on the LHCSA RFO is expected imminently. It follows a similarly dysfunctional path, heedless of the state’s worsening crisis in home care accessibility. It should be repealed immediately, permitting the Legislature to restudy the objectives behind it, along with alternative options to avoid systemic upheaval.

Telehealth Equity for Home Care & Quality Safeguards

While the final state budget excluded some of the more extensive telehealth changes contained in the Governor’s Executive State Budget proposal, telehealth discussions are expected to resume in these final weeks of legislative session. Further provisions are needed to provide home care with equitable flexibility and reimbursement, while preventing conflicts, duplication, and fragmentation of services across settings. These and other safeguards are reflected in HCA’s legislative amendments for telehealth, which we urge the Legislature to embrace.

Adopt a ‘Home Care First’ policy for NY

Home and community-based care should be the principal option over facility care, whenever appropriate. It’s also overwhelmingly preferred by patients and families, especially amid safety concerns in the COVID-19 pandemic. We continue to urge a ‘Home Care First’ policy strengthening consumers’ option to choose home care.

Our proposal would align the statutes, regulations, and appropriate state supports, ensuring that a Home Care First option transcends formality, standing as a practical reality.

Other Measures Supported by HCA

  • Extend and make permanent COVID-era regulatory relief.
  • Support rate stability for home care (S.2117/A.293).
  • Support mental health/home health collaboration for integrated physical/mental health services (amend S.4534)/A.3657).
  • Incentivize collaborative models to address health disparities (S.1374 /A.1155).
  • Support hospice access for residents of Assisted Living Programs.
  • Ensure home care worker safety and access to patients by creating a parking placard system.

If you have any questions about HCA’s proposals or would like to meet on them, please do not hesitate to contact HCA’s Director for Public Policy and Advocacy Alyssa Lovelace.