Governor Cuomo proposes 2018-19 budget: Bottom line – It’s bad for CDPA and those who use it
Governor Cuomo has released his budget and it is potentially devastating for those New Yorkers who rely on Consumer Directed Personal Assistance (CDPA) and other services to help them live independently in the community. Much of what we have fought at the Federal level is not there – there are no work requirements, for instance – however, a number of the Governor’s proposals are more backdoor approaches to dismantling CDPA and community-based services. These small cuts add up to what is clearly a direct attack on Consumer Direction!
Lobby Day is your opportunity to speak directly with your Senators and Assemblymembers and their staff about CDPA and the importance of independence and a life in the community. You can let them know directly about what cuts to the program will mean for you and the tens of thousands of New Yorkers who, like you, rely on this program.
And why is it important that you come to Lobby Day?
The Governor’s Budget increases the State’s Institutional Bias, resulting in more people leaving CDPA and going into nursing homes.
- After 6 months in a nursing home, a consumer will be considered “permanently placed” and be removed from Managed Long Term Care (MLTC), making it almost impossible to escape the nursing home ever again. Since nursing homes usually cost more than even the highest cost community-based care, MLTCs are incentivized today to keep people in the community. This proposal reverses that. High hour cases for individuals with the highest needs will now cost the plan money, and the MLTC will know they can eliminate that cost by placing them in a nursing home. Once locked away in a nursing home, the individual will lose their housing, workers, and plan – all necessary items to get back into the community. Therefore, this scheme would make it harder, if not impossible, for seniors and people with disabilities to return to their homes with their loved ones and signals a return to the pre-Olmstead attitude of locking away people with disabilities.
- Lower need individuals will be forced back into the counties. The Department of Health moved to MLTC saying that care management for all was the future and would dramatically improve care. When they did this, counties fired their staff and stripped their infrastructure due to lack of need. Now, DOH wants the people who are cheaper than the rate they pay to MLTCs back in the counties – who do not have the staff to assess or serve them. This proposal will not just lead to a lack of services for those in the county system, it will destabalize the MLTC industry and lead to a crisis for those who are left in that system.
DOH wants to end your ability to change MLTC plans. Consumers are currently in the driver’s seat when it comes to choosing their plans. If you don’t like your plan, you can switch. You can change plans every month if you want. This choice is an important check on the system, especially since there such so much interaction between consumers and plans.If the Governor has his way, individuals who are auto-enrolled will have 45 days to change plans, after which members would locked into their MLTC plan for 12 months at a time. DOH says this is necessary, because you are “shopping” for plans, and each time a consumer switches plans, hours increase by 10%. They ignore the fact that hours are based on an assessment and are not handed out freely. Increases in hours are likely justified and mean the plan someone was with did not adequately meet their needs. By the Department’s own rationale, the choice that the ability to switch plans offers is necessary to make sure plans do not short-change consumers critically needed hours.
Your Choice and Independence in CDPA is Under Attack
- DOH would require your workers to pass a criminal background check. CDPA is based on the “Dignity of Risk.” The first sentence of the law says it is was created to provide seniors and people with disabilities “greater flexibility and freedom of choice” in receiving their services. By providing consumers with the right to recruit and hire their own staff, the program assumes that the consumer, or their designated representative, will make decisions in their own best interest. It allows the consumer to fire that person if they find out they made a bad decision. Are their instances where a PA steals from their consumer? Yes. Home care workers, who already have background checks, also sometimes steal from their clients. Background checks will not solve this problem. What they do is prevent people from hiring individuals of their choosing, limiting the flexibility that the model is intended to create.
- The Governor’s budget requires your workers to be mandatory reporters for abuse. The Governor’s budget would require PAs to report to Child Protective Services or Adult Protective Services if they think you are being abused. As far as CDPAANYS is aware, this would be the only instance of a mandatory reporter being forced to report on whether or not their employer was being abused or neglected. In most circumstances, mandatory reporters report on those they provide services to, not their employer. In CDPA, this line is blurred; however, it would mean that consumers who are capable of self-directing their services would be deemed not capable of determining if they are in an abusive situation and would not be able to decide for themselves if they should remove themselves from that situation.
The Governor’s budget seeks to cut CDPA by preventing people from finding out about it
- The Governor’s budget would prevent fiscal intermediaries from advertising CDPA. Home care agencies would also be limited in their advertising.This was the strategy President Trump used to try to kill the Affordable Care Act. Governor Cuomo railed against that action. Now he is using it himself. We cannot let others who need CDPA suffer and wind up in a nursing home because the state does not want them to learn about this program and pay for their services in the community. In other words, the Governor is upset that people are finding out about a program that they qualify for and which will improve their life, so he is cutting advertising in the hopes they will stop finding out about it. The Department of Health has said they are doing this because they think people are finding out about CDPA from advertisements and it is leading to an increase in Medicaid growth. Of course, nursing homes are still allowed to advertise their services.
The budget does nothing to address stagnant wages and the workforce crisis
Earmarks $3 million for the DOH to provide for PA wage adjustments in Fee-For-Service in rural counties. Allocates $262 million in wage increases for the same workers in developmental disabilities fields. In a measure that CDPAANYS has been calling for for years, the Governor is conducting a study on the state of the workforce in community-based long term care. Unfortunately, it is just for Fee-for-service in rural areas of the state. As our report, The High Cost of Low Wages and two Assembly hearings on the subject found, the workforce shortage is a crisis in every part of the state. Further, if deemed appropriate after conducting the study, he will provide $3 million in funds to increase wages in these areas – well, $3 million less the cost of the study, which he is making low wage workers pay for. Comparatively, the Governor has guaranteed direct care workers for the developmental disability community a $262 million cash infusion for wage increases for their direct support staff. To add insult to injury, nothing is done to fix the structural problems with reimbursement in fee-for-service or managed care, problems that are leading to the stagnant and shrinking wage base.
These provisions represent a very real and immediate threat to the future of CDPA. You have the opportunity to help stop them before they start. Join us for Lobby Day 2018 and share your story. Travel and lunch scholarships are available.