Editor’s Note: Leah Farrell was interviewed about the CDR/NYAIL Medicaid proposals on WBAI Radio’s “The Largest Minority.” To listen, click here.

Leah FarrellIt’s a new year and a new Administration. Let’s talk budget.

We have proposed cost saving structural changes in Medicaid since the Pataki administration, but neither he nor Governors Spitzer or Paterson listened. Whether they were looking at eliminating entitlements or narrowly focusing on short term savings, they didn’t build what New Yorkers need for the long run.

Once again, disability advocates are proposing dramatic Medicaid savings that actually comply with the Olmstead decision and support people in the community. Seems logical, right?

Here is a breakdown on what we are proposing:

• Step 1: Transition people from nursing facilities who have expressed a desire to return to the community
• Step 2: Assist people who are at risk of entering a nursing facility by supporting them in the community
• Step 3: Utilize new community-based federal programs made available in the health care reform law
• Step 4: Shift funding from institutional settings toward community-based programs
• Step 5: Transition people from certified home health agencies to consumer directed personal assistance
• Step 6: Transition people from traditional personal care to consumer directed personal assistance
• Step 7: Expand the pool of direct care workers
• Step 8: Increase the use of assistive technology to reduce the necessity for personal care

If NYS were to implement these eight steps, the state would realize Medicaid savings of $44 million in the first year and over $1 BILLION in savings in five years.

	SAVINGS (IN MILLIONS)
STEPS	YEAR 1	YEAR 2	YEAR 3	YEAR 4	YEAR 5	TOTAL
1	$6.31	$17.01	$26.51	$34.93	$42.39	$127.15
2	$6.21	$16.77	$26.12	$34.40	$41.75	$125.25
3	$4.51	$57.54	$90.26	$90.26	$90.26	$332.83
4	$4.02	$4.10	$4.19	—	—	$12.31
5	$4.46	$12.04	$18.75	$24.71	$29.98	$89.94
5A	$1.11	$2.99	$4.66	$6.14	$7.46	$22.36
6	$1.93	$5.20	$8.10	$10.67	$12.95	$38.85
7	$11.48	$28.56	$40.78	$49.52	$55.77	$186.11
7A	$2.23	$5.56	$7.93	$9.63	$10.85	$36.20
8	$1.74	$5.02	$7.96	$10.58	$12.93	$38.23
TOTAL	$44.00	$154.79	$235.26	$270.84	$304.34	$1,009.23

If the state moved only 10% of the nursing facility residents who have expressed a desire to return to the community onto the Nursing Home Transition and Diversion (NHTD) Medicaid waiver, the state would realize $6.31M in one year. Similarly, if NYS established an expedited enrollment process in the NHTD waiver to divert only 10% of potential nursing facility admissions, the Medicaid non-federal share savings would be $6.21M in one year.SAVINGS (in millions)

ADAPT was instrumental in getting the Community First Choice (CFC) Option passed in the federal health reform law. CFC is not a waiver but rather a state plan service that has a strong consumer directed focus and can serve people who need help with not only activities of daily living but also what are called instrumental activities such as financial management and other cognitive tasks which our current personal care program cannot. This is very important to NYS. Even by serving a new population in the developmental disability/intellectual disability community as well as those with dementia, the State still stands to reduce Medicaid spending by $7.86M in the first year and a staggering $391M after five years. (This figure is achieved through recommendations 3, 5A, and 7A, which is explained in the report.) In addition to CFC, the federal health reform law established a State Balancing Incentive Payment Program to encourage states to shift funds toward community-based programs. NYS would actually save over $12M in just three years by shifting dollars from institutional settings to community-based services.

Not all home care is alike. When consumers direct their own services – as with our Consumer Directed Personal Assistance Program (CDPAP) – the savings to the state are great. New York State should promote effective, less costly programs like CDPAP. The state should facilitate people shifting from agency directed certified home health and traditional personal care to the consumer directed program whenever possible. By doing so, the state would reduce Medicaid spending by $4.46M and $1.93M, respectively, in one year.

The current state regulations in the consumer directed program do not allow children or children-in-law to receive payment for providing care for their aging parents and this leaves a population of seniors who are forced into nursing facility placement because their children cannot afford to provide care at home and maintain full time employment. If the regulations were changed – which we fully anticipate that they will be when the state adopts new regulations in 2011 – we anticipate a conservative 1% of the over 65 nursing facility residents to transition from the facility to the community on the Consumer Directed Personal Assistance Program, resulting in $11.48M in savings to the state in one year. Finally, by investing in a modest initial cost of assistive technology and providing service coordination through the NHTD waiver, a small number of people requiring 24-hour personal care services could reduce their need for full coverage and increase their independence, saving the state $1.74M in the first year.

We are distributing our proposal far and wide and have already begun discussions with Cuomo’s team. The real test will be whether they listen.
We will need ALL OF YOU to join us in the upcoming budget battle to ensure that all New Yorkers – with and without disabilities – receive the services they need to live independently in the community.

Click here to read the full proposal (For Large Print/Text Format, click here). If your organization would like to sign on in support of the proposal, please contact me at lfarrell@cdrnys.org.