State Posts Recommendations for Use of $1.6B in Federal HCBS Funds

Situation Report | July 20, 2021

As reported to members in an alert last week, the state Department of Health (DOH) has posted its Initial New York State Spending Plan for use of federal home and community-based services (HCBS) funds under the federal American Rescue Plan Act (ARPA).

The $1.6 billion in enhanced Federal Medical Assistance Percentage (FMAP) 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, are expected to grow to nearly $5 billion.

The DOH spending plan is available here. It has been made available on a new DOH webpage 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 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 and consumer directed personal assistance services through March 31, 2022 by ensuring adequate program funding is available to support growth in these programs.
  • 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 $10 million 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 $40 million in state-funds-equivalent as part of capitated premiums paid to Program of All-Inclusive Care for the Elderly (PACE) organizations to reopen safely, 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.

Some additional recommendations include:

  • Adopt workforce retention strategies, including recognition and retention bonuses, employee development and promotion initiatives, enhanced job benefits (e.g., health insurance for part-time and full-time workforce), paid training time, and other job satisfaction strategies.
  • Develop and promote completion of training programs in connection with local Workforce Investment Organizations (WIOs) and provide paid training opportunities for home care workers, so that eligible providers would utilize WIO-developed training for skills development, including the qualification of home care workers as Advanced Home Health Aides.
  • Utilize innovative technologies that assist with VBP contracting and increasing employee satisfaction, such as consumer-personal assistant matching technology, technologies that enable aides to maximize care hours to achieve full-time work, and other technologies that improve care management and VBP.
  • Develop or utilize strategies to recruit and retain a racially and ethnically diverse and culturally competent workforce, with adequate levels of demographic and linguistic representation based on historical patient populations.
  • Implement strategies for effective care management and reductions in health care spending associated with effective service delivery, which would include long-term relationship development between consumer and home care worker.
  • Build appropriate personal protective equipment (PPE) stockpiles from state-authorized sources for ensuring that home care workers are able to deliver care in a safe and effective manner through the end of COVID-19 and beyond.

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 our recommendations for the FMAP funds. These spanned a wide range, from direct provider funding supports for worker compensation to infrastructure and provider operations.

HCA policy staff are currently reviewing the state’s 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 Policy staff.
For questions or concerns about the state’s spending plan, please contact Alyssa Lovelace or Andrew Koski.