Legislature’s Budget Proposals Restore Funds, But Risks Remain as HCA Urges Continued Grassroots Advocacy   

Situation Report | March 15, 2021

Late Friday into Saturday, the state Assembly and Senate released their respective one-house budget proposals and resolutions which seek to overturn many of the Governor’s proposed health care cuts, as HCA has called for in our advocacy efforts.

Nevertheless, some considerable risk areas remain, particularly vestiges of the Governor’s telehealth proposal, which would remove “originating site” requirements in the current law without the accompanying safeguards or the update for home telehealth sought by HCA. Also, the Senate has embraced a previously reported standalone bill on aide compensation, which raises concerns about reimbursement adequacy to cover the cost of the mandate.

Both houses are expected to act on their proposals today, setting the stage for Legislative Conference Committees and further negotiations with the Governor, both of which could result in further amendments leading up to a final budget by the April 1 deadline — a critical time for your continued advocacy alongside HCA.

HCA’s policy staff are currently reviewing the budget documents and will provide the membership with a more detailed update as we continue our analysis in the coming days. Below are some further details.

Funding restored 

Both houses propose to repeal the state’s Medicaid Global Cap. They also reject the Executive’s proposal to reduce Workforce Recruitment and Retention program funding by an additional 25 percent and they remove the 1 percent across-the-board Medicaid cut. HCA is seeking to determine what this also means for the Governor’s proposal to continue the 1.5-percent across-the-board cuts from the prior fiscal year.


Both the Assembly and Senate fully rejected the Executive’s proposal to implement new penalties for health care providers (HCA advocated against these penalties), as well as a package of nursing home reforms, though some related proposals exist as standalone bills in the legislative process.


Both houses modified the Executive proposal on telehealth. The Assembly redefined “originating site.” The Senate amended telehealth reform to allow for maintaining flexibilities with distant sites, adding certified peer recovery advocates as eligible providers, and creating reimbursement parity for services delivered by telehealth.

HCA has advanced telehealth language to both houses and will continue to advocate critical safeguards for patients, guardrails against duplication of remote services, and equitable coverage of telehealth services by duly licensed home care providers.

Compensation Thresholds for Home Care Aides and Wage Parity Change

The Senate also included a version of recently introduced language by Senator Rachel May that would create the Fair Pay for Home Care Act. It would require pay at no less than 106 percent of the minimum wage or applicable wage law by April 1, reaching 112 percent by October. These thresholds appear to differ from Senator May’s standalone bill, as extensively reported to the membership, which established a threshold of 150 percent. The Senate allocates $624 million in funding for minimum wage for home care workers. It also proposes to increase the benefit portion of the Wage Parity Law from $4.09 to $4.27 in New York City and from $3.22 to $3.38 on Long Island and Westchester,

While the Senate’s compensation proposal appears to recognize the need for investments, we’ve stressed to Senator May and other sponsors throughout this year’s session that Medicaid rates have historically underfunded the current obligations for paying wages and related costs, with no permanent assurances of funding for mandates that are ongoing. Moreover, the legislation would not cover the increased costs for aide service to Medicare or other beneficiaries triggered by the bill. We will continue to raise these concerns in our budget advocacy.

Consumer Directed Personal Assistance Program (CDPAP) 

The Senate proposes language that requires the Commissioner of Health to reoffer contracts for CDPAP fiscal intermediaries (FIs) in order to ensure FIs are physically located in the counties they serve, and to ensure fiscal intermediaries have experience serving individuals with developmental disabilities and serving racial and ethnic minorities. The Senate would also require at least two FIs headquartered in each city with a population of 200,000 or more, provide an additional five awards to not-for-profit entities operating prior to 2012 and five more to entities primarily providing services to racial and ethnic minorities.

Competency Programs 

The Senate advanced language to require the state Department of Health to establish a schedule for when competency exams for home care workers that reside outside the state will be offered.

What’s Next 

This week, joint legislative conference committees will commence in an effort to come to agreement on a final state budget.

HCA will continue our advocacy for home care investment, further protections and guardrails in the proposed telehealth reforms, and our Home Care First agenda supporting a policy landscape of fiscal, regulatory, and program support for home and community-based providers.

In the meantime, please make your legislative appointments now as outlined in our Virtual Advocacy challenge here.

Please also use our Legislative Action Center campaign to send a message to your legislators here; plus, watch and share our Home Care First video advocacy campaign which also has an important call-to-action for you, your staff, patients and the public to send lawmakers.

Please contact HCA’s Director for Public Policy and Advocacy Alyssa Lovelace for questions or concerns.