Candidate Questionnaire Response: Diane Savino (D)

Candidate Name
Diane Savino

Email Address

Major Party Endorsement Sought

Additional Party Lines Sought

Program Introduction

Consumer Directed Personal Assistance (CDPA) is a Medicaid program that empowers seniors and those with physical disabilities who need assistance with activities of daily living by giving them control over the delivery of their services. CDPA is critical to almost 40,000 people’s ability to live fulfilling and independent lives in their community. To meet their needs, over 60,000 people are needed to work as personal assistants (PAs), the direct care staff in this program. Consumers who use the service are the employer of their personal assistants (PAs), and are therefore responsible for recruiting, hiring, training, scheduling, supervising, and if necessary, terminating their staff. Key to this system is the tenet of “dignity of risk”, which recognizes that people with disabilities are equally capable of making decisions about their own care as the mainstream population.

A. Have you ever worked with CDPA consumers or the disability community in a private or professional capacity?
Yes. As a legislator, I have been a champion for the disabled community in the Senate. In 2014 I secured funding for SICIL to provide annual summer programs for individuals with disabilities so they could participate in integrated community and social activities at no cost. I helped fight for the Governor to raise the wage of DSPs, because their work is worth so much more that a minimum wage. Most recently I sponsored the law to expand the Disabled Homeowners Exemption (DHE), raising the income cap to 50% of the property tax exemption, thus keeping more people in their own homes.

B. On a scale of one to five (1-5), one being the least familiar and five being the most, what is your understanding of Medicaid long term services and supports (LTSS)?
5. As a member and recently as the vice-chair of the Senate Finance Committee, I have sat through hundreds of hours of testimony, much of that on health care and social services, which has provided me with an understanding from government agencies, care providers and consumers. When an earlier iteration of the Single-payer health bill was being pushed, I was the person pointing and speaking out that long-term disability insurance was not addressed in the bill.

C. Are there any changes you would make in the administration or provision of home care services, including CDPA?
Yes. I believe I have been one of the loudest voices in Albany to increase the pay for all direct care workers. We cannot pit one group against the other, we must raise the wages for all to ensure quality care for all. Additionally, we need to further level the playing field for CDPAs by allowing them to advertise their services the same as nursing homes do.

D. What do you consider your primary accomplishments in relation to LTSS?
In 2016, I was made aware of a growing problem in my district and others that was drawing funds from “real” adult social day programs and some inconsistent application of state regulations that were hurting good adult social day programs. While the bill was vetoed (VM 288 of 2016) It forced the administration to be aware of these problems and I worked with DOH and SOFA to find solutions.

E. If elected, will you commit to meeting with CDPAANYS and representatives of the disability community and seek their input on issues impacting the delivery of their care?
Yes. As I have in the past, particularly during the state budget process, I will I continue to meet with CDPAANYS, their workers and clients.

Expanding Access to CDPA and community-based long-term supports and services

[bg_collapse view=”link-list” color=”#4a4949″ expand_text=”Click here for background information on expanding access to CDPA and community-based LTSS.” collapse_text=”Show Less” ]Research has shown that CDPA meets the goals of the Triple Aim seamlessly by achieving better health outcomes, increased patient satisfaction, and lower costs. Because of this, as well as the program’s ability to offer flexibility and independence, New York’s Olmstead Plan identifies that CDPA should be the first choice for Medicaid recipients in need of long-term care.

Despite this, rapid growth within CDPA has led to attacks on the program from numerous sides. Proposals, some of which have been enacted, have sought to slow the growth of Medicaid by limiting the free speech rights of fiscal intermediaries in advertising services to consumers, limiting consumer choice of FIs, and facilitating institutionalization over community-based services.

Further, as the state continues to age, the increased need for long-term supports and services, both within Medicaid and among those who do not qualify for the program, is placing the entire system and those who rely on it under increasing strain. According to AARP, almost 2.6 million family caregivers provide 2.4 billion hours of uncompensated care each year in New York, at an estimated value of $31.3 billion. However, this care is far from free, as the impact to the economy in lost worker productivity is tremendous. This lost productivity also results in burn-out amongst family trying to balance caring for their loved ones while holding down a full-time job and often results in the early institutionalization of those who require services. Those who provide the services, usually women, often see their careers hindered due to lost promotions and raises because of the time they are taking to care for loved ones.

The continued reliance on unpaid family supports is not a viable long-term solution, nor is it consistent with New York’s values. We must ensure that individuals have adequate supports to provide them with the services they need, in the community, from the individuals they wish to provide them care, whether or not they are Medicaid recipients. In some instances, this may be paid or unpaid familial supports. In other cases, they may want paid home care providers, either through CDPA or a traditional home care agency.

A. Do you support efforts to increase awareness of and access to CDPA?
Yes. I am a huge advocate in consumer choice and keeping seniors and people with disabilities in their own homes. CDPA is an important option to enable those who need extra assistance to remain in their homes with high quality care. We need to remove obstacles that prevent potential CDPA consumers from leaving of these services and how to avail themselves of the services.
B. If elected, will you oppose any policy that encourages institutionalization over community-based care?
Yes. Seniors and persons with disabilities should be able to have the preference to live their lives in their own home, rather than be coerced into medical institutions. One should have the option to live their life in dignity, by receiving care in their home if they so choose.
C. If elected, will you support and implement policies aimed at promoting the New York State’s Olmstead Plan’s priority of ensuring CDPA is the first option available to all who need it?
Yes. I believe CDPAS need to be an integral part of moving those with disabilities from institutional setting to independent living and in the future keeping person with disabilities from institutionalization.
D. If elected, will you support efforts to expand CDPA beyond a program that is only available to those on Medicaid and the Expanded In-Home Services for the Elderly Program (EISEP)?
Yes. I see no reason why person with private insurance should be prevented from availing themselves of the resources of CDPAs provided those without means are not adversely impacted.
E. Will you oppose any effort infringing on consumer choice as it relates to CDPA or community based services, including efforts to limit the number of fiscal intermediaries who administer services on behalf of consumers?

F. If elected, will you ensure that long-term supports and services such as CDPA are included in any single payer proposal, such as New York Health?
Yes. As a cosponsor of the New York Health Act, It is my goal to make sure all New Yorkers have access to optimal levels of health care. CDPA opens a door for New Yorkers to have more control over how they want their care delivered. CDPA fits right into forwarding the overall goal of the New York Health Act. As I mentioned earlier, when an earlier iteration of the Single-payer health bill was being pushed, I was the person pointing and speaking out that long-term disability insurance was not addressed in the bill.

Wages and the PA workforce crisis

[bg_collapse view=”link-list” color=”#4a4949″ expand_text=”Click here for background information on wages and the PA workforce crisis.” collapse_text=”Show Less” ]Home care, and in particular CDPA, has been one of the primary growth industries across the state over the last five years. Despite that, New York State finds itself in the midst of a workforce crisis for individuals receiving services at home. A CDPAANYS report entitled “The High Cost of Low Wages” revealed that more than half of consumers lived up to six months without essential support for critical activities of daily living while seeking a personal assistant (PA), and the majority of PAs cite low wages as their reason for quitting. There are many reasons that the state is in the midst of a workforce crisis; however, all of them are related to wages.

In 2006, Personal assistants (PAs), the workers in CDPA, earned approximately 150% of the minimum wage. Today, due to Medicaid reimbursement that is, on average, lower than it was a decade ago, being a PA is often a minimum wage position. Even fast food and retail jobs in the same regions often pay more per hour due to the higher minimum wage for fast food workers, a trend that will be made permanent Upstate, where the fast-food wage goes to $15.00/hr. while the minimum wage for all others stops at $12.50/hr.

While those who rely on homecare suffer because the government doesn’t invest in workers, that same government spends disproportionate sums of money on economic development projects that produce relatively few jobs for the investment. A recent investment of $750 million in Buffalo to build a new facility for SolarCity, amounts to, under the most generous calculations, spending $160,000 per job. Based only on the manufacturing and sales jobs they promised to create, it is closer to $541,000 per job.

Meanwhile, Medicaid reimbursement rates for CDPA have remained stagnant or decreased. This is true even though the cost of doing business continues to rise and the fact that personal care and CDPA are the fastest growing industries. According to Mercer Consulting, New York is facing a projected shortage of 20,000 homecare workers by 2022. Reimbursement rates were formerly adjusted according to what is commonly referred to as the trend factor, which ensured they were consistent with inflation. The trend factor was eliminated during the financial crisis in 2009 and has not been reinstated, despite the steady growth in costs since that year. The fallout from this stagnation has worsened since 2011 and made it increasingly difficult for FIs to remain financially solvent, forcing many to stop offering PAs pay raises, and in some cases, cutting hourly pay. A lack of transparency or accountability with managed care plans has exacerbated the downward spiral in reimbursement rates.

A. If elected, will you commit to a funded PA wage that is at least 150% of the state minimum wage with indexing to ensure that these jobs remain competitive with restaurant and retail work?
Yes. Direct Service Professionals were not included in the living wage increase, and that is a shame. I have fought in the Senate to include DSP’s in this debate. The work these professionals do is worth much more than a minimum wage.
B. If elected, will you commit to restoring the trend factor adjustment to Medicaid, once again allowing wages to increase with inflation?
I would look at the trend factor and any other proposal that would help provide proper wages to those who care for our most vulnerable residents
C. If elected, will you commit to increasing transparency and accountability for managed care plans by requiring that they reimburse providers a sufficient amount to cover the basic costs of doing business?
D. If elected, will you commit to investing economic development money into home care and CDPA in order to ensure that the workforce exists to provide needed services to those who need them?
Yes. This would be an interesting and new approach to health care funding that I would be eager to investigate

Community First Choice Option

[bg_collapse view=”link-list” color=”#4a4949″ expand_text=”Click here for background information on the Community First Choice Option.” collapse_text=”Show Less” ]The disability community fought for and won a provision in the Affordable Care Act (ACA) called the Community First Choice Option (CFCO). CFCO incentivizes states to provide services to nursing home eligible individuals in the community by increasing the federal medical assistance percentage (FMAP), also known as the federal matching funds, for those services by 6%. In 2012, New York pledged to move forward with implementation of CFCO. New York received federal approval for these funds in October 2015; however, CFCO services critical to allowing individuals to live independently in the community remain unimplemented.

Further, reimbursement practices the Federal Centers for Medicare and Medicaid Services (CMS) has flagged as discriminatory based on an individual’s disability type continue. The New York State Department of Health indicated that Fiscal Intermediaries in CDPA are reimbursed about $3 less per hour than licensed home care service agencies (LHCSAs), who provide personal care, and about $20 less per hour than community habilitation agencies within the developmental disabilities system. When CFCO was approved, the state was given one year to address this discrepancy. Despite the fact that the state has collected over $500 million in additional revenue through the extra 6% in additional FMAP funding, this problem remains unaddressed.

A. If elected, will you require DOH to implement all services included in the CFCO benefit package and break down the service silos that exist between different agencies that prevent proper service delivery today, including full supervision and cuing for those who need it separate from discreet activities of daily living?

B. If elected, will you ensure New York becomes compliant with CMS requirements and equalize reimbursement between CDPA, personal care, and community habilitation?