Drastic CDPAP Changes and other Medicaid Outcomes of Final NYS 24-25 Budget

FINAL NYS ENACTED BUDGET for 2024-25 Make Huge Changes in CDPAP That will Potentially Disrupt Care for 200,000 New Yorkers. 

1.  CDPAP CHANGES ENACTED:

• SINGLE FISCAL INTERMEDIARY -- Now there are more than 600 Fiscal Intermediaries (FI's) that handle payroll and benefits for all Personal Assistants (PA) in CDPAP.  These FI's process their tax documents, check immigration and vaccine status, and sometimes help the consumer find and train a PA.  The FI's contract with and are paid by the MLTC plans, mainstream managed care plans, and local Dept. of Social Services (DSS) which authorize the CDPAP services.  

  • NYS DOH will contract with a SINGLE FI that will now contract with all plans and local DSS.   The law says the SINGLE FI must be operating in another state as a statewide FI - limiting the possible candidates. 

  • That single FI will subcontract with a small number of existing FIs - one or more of the eleven Independent LIving Centers (ILCs) that operate FI programs, and just a few others. 

  • By April 1, 2025, all other FIs must stop operating. By that time, all 200,000 CDPAP consumers and their PA's will be transitioned to the new SINGLE FI or one of their few subcontractors. 

  • See Spectrum news broadcast with disability rights leaders opposing this change (Apr. 11, 2024)

•  POSSIBLE NEW TRAINING REQUIREMENTS FOR CDPAP PA's -

  • The budget law authorizes DOH to adopt regulations “to carry out the objectives of the program including minimum safety, health & immunization criteria and training requirements for PA’s.

  • A hallmark of CDPAP since it started as a demo in the 1980’s, and statewide under 1995 state law is that the consumer or their rep trains the PA.  Only people who can show ability to direct and train PAs are approved for CDPAP – so no outside training is necessary.

  • Standard aide training doesn’t cover skilled tasks PA’s may perform – injecting insulin, administering oxygen or tube feeding, etc.  Now, consumer or family trains or arranges training. 

  • Adding this burden will deter PA’s from working – worsening the workforce shortage and causing more delays and access problems for consumers.

2. THESE CDPAP CUTS WERE DEFEATED -  Proposed by Gov Hochul in her proposed budget and in the 30-day Amendment - described here  We thank the Senate & Assembly for standing strong to reject these cuts in their one-house bills,    Read NYLAG's Statement Opposing the CDPAP Cuts

• CUT in hourly  CDPAP wages by eliminating the "prevailing wage" increase in New York City, Long Island, and Westchester. 

• Limiting CDPAP  to people who can "direct" their own care.  Anyone needing a Designated Representative would have been disqualified. This would  have disqualified  all people who have Alzheimer's disease or other cognitive impairments, those with Traumatic Brain Injuries and Intellectual and Developmental Disabilities, and children under 18 with severe disabilities. 

3. Instead of scapegoating CDPAP for problems inherent in the MLTC model,  NYLAG Supports the Home Care Savings & Reinvestment Act  (S8700/A8470)(Rivera/Paulin)

This law  would repeal the Managed Long Term Care program and replace it with a Managed Fee for Service program. 

• Read NYLAG's memorandum in support of this bill.  NYLAG's support is based on 12 years of advocacy, both on behalf of individual consumers and in class action litigation, and NYLAG's study of data in its MLTC Data Transparency Project and Report, 

• Watch this powerful 3-minute film called #CareNOTProfits about the bill proposing to replace MLTC.  Learn more at https://www.nycaringmajority.org/carenotprofits.

• Paul Francis, who served under four New York Governors in roles including Budget Director and Director of Agency Redesign and later the Deputy Secretary for Health and Human Services under  Gov. Cuomo when the MLTC program launched in 2011, now heads a think tank that issued a critical review of MLTC, agreeing that the Home Care Savings & Reinvestment Act  (S8700/A8470)(Rivera/Paulin) replacing the MLTC program with a new system will save money and should be strongly considered.   Read the Step Two Project  report here.  

• See FACT SHEET on the Home Care Savings & Reinvestment Act

4. BUDGET DID NOT REPEAL Cuts Enacted in 2020 with Medicaid Redesign Team II -
that were put on hold because of COVID   - See Coalition Statement Asking to:

• 30-Month Lookback & Transfer Penalty that will  Delay and Deny Vital Home Care Services.  We thank the Senate for including Repeal of the Lookback in its One House Bill - incorporating repeal bill S.6414/A.9278  (Skoufis/Paulin). Will be implemented in 2025 if not repealed. 

  • See NYLAG's memo supporting Lookback repeal bill.  

• 3-ADL Requirement that will deny Medicaid home care illegally to Those With Vision Impairments, Intellectual & Developmental disabilities, Traumatic Brain Injuries, and many other disabilities. Will be implemented by Fall 2024 if not repealed.

  • See NYLAG's Memo Supporting  a bill S.328/A.6346 (Rivera/Paulin) to repeal the ADL thresholds . 

5. SOME GOOD THINGS PASSED IN THE NYS BUDGET  - thanks to Governor Hochul and Legislature

• Expanded Continuous Medicaid coverage from birth to Age 6 - See Coalition Statement in support

• Eliminated co-pays for insulin (TED Part EE)

• Subsidies for Qualified Health Plans (QHPs) for those who buy insurance coverage under the Affordable Care Act, whose incomes are too high for Medicaid (Part J)

• Prescription Drugs – Legisltature succeeded in rejecting elimination of “prescriber prevails” for those Medicaid recipients who do not have Medicare drug coverage.

• Created the Medicaid Investment Fund to reserve revenue derived from a new tax on managed care plans --  which will need federal approval

• ADULT HOMES – Rejected proposed elimination of funding for and repeal of the EQUAL program (Part L) 

6.   BUDGET FAILED TO ENACT  THESE IMPORTANT INITIATIVES  --

1. Coverage4All -   Essential Plan coverage was not expanded for people who are undocumented.  Gov. refused to build on last year's expansion of coverage for people age 65+ that went into effect Jan. 1, 2024  -- now it's time to close the coverage gap for all.  Thanks to both the Assembly and Senate for supporting this expansion in their one-house bills.  See examples of NYLAG clients who need this coverage in our 2024-25  Budget Priorities. 

2. Repeal the global cap (S.4861) - we support Senate's proposal in the one-house bill and rejection of unallocated cuts

3. Phase out the asset limit for older adults and people with disabilities by increasing it next year and then repealing it (new Part NN) (A.5940-A/S.4881-A)-  Read our coalition memo to see why we strongly support this Senate proposal in the one-house bill 

4. Increase in Personal Needs Allowance in Nursing Homes and other medical facilities as proposed by the Senate was not  included in the final budget.  The $50 monthly allowance has not increased since 1981.  Residents need this allowance to pay for clothing,  haircuts,  a meal or ice cream treat outside the facility,  newspapers, magazines or books, or a greeting card for loved ones   (New Part YY – S. 7786).

5. Instead of permanently carving out school-based health centers from  Medicaid Managed Care, as Assembly proposed, transitioning these centers to managed care was postponed one year to April 1, 2025.    

6. Increase the Medical Loss Ratio (MLR) for all managed care plans from 89% to 91% as proposed by the Assembly in their one-house 

7. Advocates fought the proposed State authority to  stop covering  certain Over the Counter drugs with no public notice.  In the final budget, this authority was enacted with some public notice and opportunity to comment.  

See More Resources on NYS Budget -

• NYLAG NYS 2024-25 Budget Priorities here  and more here  

• Empire Justice Center Testimony on Health issues in Proposed FY 2024-25 State Budget 

• Medicaid Matters NY Annual Consumer Budget Checklist

• Medicaid Matters NY Testimony to Legislature on Health Issues in FY 2024-25 State budget 

• See Consumer Directed Action of NY Priorities for Budget  and more  on CDANY website  - sign up for CDANY's newsletter here

• NY Caring Majority website

For information contact  eflrp@nylag.org