Underscores adverse impact of proposed cuts, eligibility changes, structural limits and urges support for process improvements, home care licensure standards, workforce and infrastructure
ALBANY — HCA President Joanne Cunningham testified today before a joint legislative panel on the Medicaid and health areas of the state budget. Her testimony, on behalf of HCA’s home care, hospice and Managed Long Term Care providers and plans, is available at https://hca-nys.org/wp-content/uploads/2018/02/201819HCAStateBudgetTestimonyUpdatedFeb132018.pdf.
Of primary concern in this Executive Budget are the proposed cuts and program changes that impact MLTCs and home care, Ms. Cunningham said.
“Virtually the entire long term care Medicaid and Medicare patient population in New York State has been moved under the care of MLTCs and their providers. The Administration has removed most other options,” Ms. Cunningham said.
“The budget proposals negatively affecting MLTCs, providers and the patients they serve would impose upon the decision-making capacities of plans and providers to coordinate necessary services and supports,” she added, noting how the “financial standing of MLTCs and their network providers are inextricably linked.”
She cited HCA’s report Home Care, Hospice and Managed Long Term Care Financial and Program Trends, which finds that 70% of Certified Home Health Agencies (i.e., home care providers) and 62% of MLTCs (the managed care plans who predominately administer Medicaid home care services on behalf of the state) are not being compensated to meet the cost of the services they provide, and are thus being forced to operate at negative finance levels.
“The proposed cuts in the Executive budget would harm access to care and care continuity for patients whose eligibility would change, and would further exacerbate the already precarious financial condition of plans and service providers,” she said.
Ms. Cunningham addressed the budget’s proposed arbitrary limit of ten on the number of Licensed Home Care Services Agency (LHCSA) providers that an MLTC may contract with to provide services. “There is no clinical or financial rationale for this proposal whatsoever,” she said in her written remarks.
“Not only does this proposal have questionable savings rationale, but it greatly underappreciates the burgeoning demand for home care, the geographic limitations of individual providers, and critically, the important differentiation that exists in home care,” she added. “Currently, a LHCSA may specialize in care to specific patient populations. In other circumstances, patients come to trust the individual employed by a particular provider for cultural or other social reasons that are determining factors in the experience and outcomes of care.” These factors would be greatly disrupted under the limits proposed by the budget.
Ms. Cunningham urged the need for funds to support the direct-care workforce, given that the rising minimum wage “is a statutory requirement and, therefore, must be funded in the state’s obligation to meet human service providers’ costs under the auspices of the Medicaid program.” She urged support for minimum wage funding incorporated in the Executive budget and called for a more “even, transparent, timely and consistent process” for the distribution of funds needed for providers and plans to meet labor and other mandates.
HCA is also calling for a more proportionate share of health care transformation funds to support home care infrastructure; a multi-pronged plan for workforce support to address recruitment and retention; reinforcement of existing standards of home care licensure to protect patient quality of care; and support for programmatic initiatives that foster home care’s potential to save costs and improve public health in priority areas such as sepsis prevention and response, opioid and addiction management, asthma, and other clinical priorities that match overarching state policy goals.
These and other proposals are referenced in HCA’s testimony as well as in our 2018 Budget and Legislative Asks document which outlines HCA’s budget and legislative platform in six areas here: https://hca-nys.org/wp-content/uploads/2018/02/2018BudgetandLegislativeAsks-1.pdf.
Roger L. Noyes
Home Care Association of New York State (HCA)
(518) 810-0665 (office)
(518) 275-6961 (cell)