What has been an intense and truncated budget season is coming to a close as Legislators begin to vote on the final budget bills.  The bills are printed, the advocacy dust is settled and now we must look at how the soon to be enacted budget will impact the independence and integration of people with disabilities.

Center for Disability Rights would like to thank all of the advocates who made their voices heard through calls, Capwiz alerts, and trips to Albany.  We extend a special thanks to CDPAANYS for all of their work and for organizing statewide rallies and press conferences on several important issues – including an impressive NYC rally lead by our advocate friends downstate.  While there are some significant wins, there is still a lot to be done to ensure that all people are afforded the services, supports, and rights to live in the community and out of institutions.

Due process protections.

The Assembly’s proposed due process protections (e.g. aid continuing) for people in managed care was not included in the final budget.  We are deeply concerned that these protections were not addressed and we will continue to fight in every way we can, including advocating for the passage of A.4996, to ensure that people with disabilities are afforded adequate due process rights in all systems of care management.

Sufficient wages for community-based workers.

The Governor’s budget proposed a requirement that managed care contracts provide for sufficient wages for nursing facility workers and we advocated for parity language for community-based direct care workers.   Neither was included in the final budget.  While we are disappointed to not receive language that supports the development of a qualified workforce in community-based programs, it would have been terrible for the system to incentivize nursing facilities over the community.

OMH downsizing.

The Governor’s proposal to further downsize the State’s psychiatric hospital system and reinvest savings into community-based services was rejected by the Legislature, requiring a restoration of $20M. According to sources, labor was the primary opponent to closing these psychiatric hospitals.  While OMH may begin planning, this is a significant step backwards.

Prompt pay protections for FIs.

Fiscal Intermediaries (FIs) contracting with mainstream managed care plans and managed long term care plans now have protections to ensure that they receive timely payment, assuring that attendants will receive the wages they work hard for.  This protection is critical for the sustainability of the consumer directed personal assistance program.

Spousal/parental refusal.

We are pleased to report that this was protected in the final budget.  Beginning 2014, these protections will be provided at the federal level by extending Medicaid spousal impoverishment rules to community-based services.

Ombuds.

The State is committed to funding the ombuds program for people with disabilities and chronic illnesses in managed care.  The budget allows for the state to use reinvestment funds in the Super Waiver when available and the State is moving forward with the design of the RFP.

Provider cuts.

The human services Cost of Living Adjustment (COLA) was once again deferred for this fiscal year.  The trend factor was eliminated.   The budget does not extend the 2% across the board cut to providers in the fourth quarter as long as it remains under the global cap.

Scope of practice for home health aides.

The Governor’s proposal to expand the scope of practice for home health aides based off of the recommendations of the Medicaid Redesign Team was rejected.

Expedited managed care.

The budget allows the State to fold in currently excluded and exempt populations into managed care without requiring legislative approval for each carve in.  Once program features and reimbursement rates are established, the Commissioner may authorize the phase in of these populations.  No public vetting or legislative oversight mechanisms were included.

FIDA.

The State’s demonstration to integrate Medicare and Medicaid services for a group of dually eligible individuals is included in the budget, and primarily focuses on the portion of the demonstration that will serve people with developmental disabilities.

DISCO.

The budget includes explicit details on OPWDD’s developmental disability individual support and care coordination organizations (DISCOs) including enrollment, assessment, requirements of DISCOs, and more. DISCOs may not do initial assessments but are permitted to do reassessments.

Minimum wage.

The minimum wage is scheduled to increase incrementally up to $9.00 on and after December 31, 2015.  Unfortunately, there was no change to rules that allow people with disabilities to receive earnings far below minimum wage.

Medicaid reinvestment for supportive housing.

The total allocation was reduced by $5M.  It is still unclear how these funds will be used but we expect them to be split between capital funding, pilots and rental/service subsidies, as well for a portion of the nursing facility transition and diversion waiver subsidy.

Access to Home.

This program was maintained at the same funding level as last year, $1M.  We are pleased that this program was protected and maintained, but this funding is far below the level of need.

“Helping People Help Themselves”