MRT Moves Forward on Devastating Recommendations to Cut, Cap and Restrict Long Term Care, Home Care  

The Medicaid Redesign Team (MRT) met for a final time on March 19 over conference call to move forward on a breathtaking set of proposals that, if approved by the Legislature and Governor, would be devastating for the home and community-based care sector at a time when the system is already overburdened by a crushing global health crisis.  

“We know that time is short to pass a state budget,” said HCA President Al Cardillo in a statement to the media, reported by Politico New York and the New York Daily News. “But that is no reason to advance these proposals heedless of the consequences.” 

He added: “We call on the Legislature to: look hard at MRT recommendations for which cost savings are disputable at the levels assigned; consider alternative cost-savings measures advanced by HCA but declined by the MRT; and explore new revenue opportunities from federal aid and other sources to better realign an impact that otherwise would be borne disproportionately by the long term care sector.” 

Read the full remarks here.

During the meeting, State Budget Director Robert Mujica stressed the need to pass these proposals now, despite the COVID-19 pressures and its fiscal impacts already surmounting Medicaid programs and services, citing a revised forecast on revenue that is $7 billion lower than before the crisis, when the state was already facing a multi-billion-dollar gap.     

The $2.5 billion in proposals approved by the MRT are sweeping and stunning in nature, including some that have appeared anew since the previous MRT discussions.  

Briefly, these include an increase in the current across-the-board Medicaid cuts from 1 percent to 1.875 percent, a request for proposals process to limit the number of Licensed Home Care Services Agencies (LHCSAs), enrollment caps on Managed Long Term Care, an independent assessor process for all of home care, an array of structural changes to the Consumer Directed Personal Assistance Program (CDPAP), $45 million in cuts to worker recruitment and retention funds, and others too numerous to mention in this initial briefing to the membership.  

The Executive Summary of the proposals is here.

As entire operations are seized by the COVID-19 crisis, little information is known at this time whether the Legislature is expected to embrace these recommendations and to what extent. Senate, Assembly and Executive budget negotiators met over this past weekend on health and non-health areas of the budget; yesterday, Medicaid/health meetings were held throughout the day.

HCA has weighed in every way possible under the present COVID-19 restrictions to urge rejection and/or reformulation of the MRT’s adverse proposals, but the Legislature’s propensity and ability to rebut the MRT proposals appear limited. The federal COVID-19 aid bill appears to require that states leave their Medicaid programs untouched in order to qualify for funds, including approximately $6.7 billion pledged to New York State, but it is not known how the final aid package will read or be interpreted. This proviso has reportedly delayed the budget process, hinging in large part on the viability of MRT proposals and other Medicaid considerations, as lawmakers look to complete a budget this week in order to close session and focus on the COVID-19 crisis.  

We expect more actions and developments very soon and will report back to the membership by e-mail alert.