Budget Encourages Managed Care Plans to Institutionalize Disabled People, by the State’s Admission

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The State passed its budget last week. Much of the media attention focused on the Centene-Fidelis merger, the opioid plan, and the exemption of Yeshivas from state education requirements. What received far less attention from the media was the State’s decision to “carve” nursing home placements out of the Medicaid managed care system after three months if someone is deemed permanently placed. While many lawmakers might view this as a regulatory shift, disability advocates point out that it creates an incentive to institutionalize. “This tells the [managed long-term care] plans if anyone isn’t profitable for you, just ship them off to a nursing home and then they will be the state’s problem,” says Stephanie Woodward, an activist who works with the disability rights organization ADAPT. Woodward spent much of the last year getting arrested while fighting Republican attempts to cut Medicaid and repeal the Affordable Care Act. “I was arrested nine times last year trying to stop federal policies that would force our community into nursing facilities, I never expected to come home to New York to find our governor and legislature trying to do exactly the same thing!”

Disability advocates say the state is well aware of the effect this policy will have and point to the state’s own Olmstead plan issued in 2013 to promote community integration as evidence; “Building on the Care Management for All initiative, reforms in the 2012-2013 budget removed the financial incentives that may have encouraged nursing home placement. Previously, nursing home costs were “carved out” of managed care rates and were instead covered by the state. This policy had the potential to encourage managed care plans to pressure high-cost people served in community-based settings to enter nursing homes.”[1]

Bobbi Wallach, Chair of the Board of Directors at the Center for Disability Rights and herself someone who escaped a nursing home seven years ago says, “They clearly understand what this does; it’s not as if the Olmstead plan was written by another governor. If he knew then that it encouraged institutionalization he knows that it does the same now. And saying the State had a bad year financially is no excuse. No one’s freedom should be dependent on the fiscal health of the State.”

Advocates also point to state policies that are biased towards institutionalization, such as that funding for services in nursing facilities is required while home and community-based services are optional and often the first services to be cut in any budget crisis. Jenson Caraballo from Rochester fell prey to this bias when he was only 15. “I needed long-term supports and services and they told me the only way I could get them was if I moved into a nursing home. They kept me there for six years before I was able to arrange for supports in the community. No one should have to spend their teens and early twenties, or any age in those horrible places.”

“The Governor and the legislature are trying to pay for their budget with the lives and liberty of disabled New Yorkers,” said Gregg Beratan, Manager of Government Affairs at the Center for Disability Rights, “This policy makes the contempt in which the State’s politicians hold the Disability Community crystal clear.” 



[1] P.14 – https://www.governor.ny.gov/sites/governor.ny.gov/files/archive/assets/documents/olmstead-cabinet-report101013.pdf