Candidate Questionnaire Response: Kevindaryan Lujan (D)

[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.

[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.

[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.