Albany’s Final State Budget Must Protect Specialized Long Term Care Services for Vulnerable New Yorkers
Governor Hochul and the state legislature will soon move into the final phase of the 2022-23 budget making process, and while managing the state’s COVID recovery continues to be a top priority, a separate proposal, if enacted, will disrupt the delivery of essential services to a group that has been disproportionately affected by the pandemic — older adults and people with disabilities. This proposal to competitively bid the state’s Medicaid managed care program, advanced as part of the executive budget, was wisely rejected by both houses of the legislature in their initial budget actions. We urge Governor Hochul to abandon this measure as the April 1 fiscal year deadline approaches.
The executive budget’s competitive procurement of Medicaid managed care plans, if implemented, would force as many as 150,000 older adults and people with disabilities who receive in-home managed long term care services to change their managed care plan, possibly their provider, and the familiar aides they work with each day. While placing essential services at risk, this proposal carries no savings in the coming fiscal year.
MLTC plans provide active care management and coordination, enabling approximately 275,000 vulnerable individuals statewide to live independently in the community, rather than a nursing home. These individuals need extensive assistance with activities of daily living, such as dressing, bathing, and moving from bed to a chair. They include older New Yorkers with cognitive deficits or physical disabilities and chronic medical conditions, as well as younger adults with conditions such as neurodegenerative disorders or spinal cord injuries.
The competitive bidding process would substantially reduce the number of MLTC plans, cutting the number of plans in New York City alone from an existing 16 to no more than five. Consumers enrolled with the losing bidders will have to change plans, familiarize new care managers with their needs, and shift to new home care providers if their providers are not members of their new plan’s network. Consumers entering the program will have a far more limited selection of plans.
Based on the state’s expressed goal of selecting plans that offer multiple managed care products over wide geographic areas, it is likely that nearly a dozen MLTC plans sponsored by long-term care providers specializing in serving older adults and people with disabilities will be forced to close. MLTC plans led by non-profit providers, like those that are members of LeadingAge New York, develop longstanding relationships with the individuals they serve through dedicated and trusted care managers. The care managers respond to consumers’ concerns, connect them to the medical and supportive care they need, arrange transportation to appointments and delivery of supplies, and implement creative solutions to their challenges.
Governor Hochul in her few months in office has taken significant steps to help us emerge from the pandemic. However, this proposal will add to the distress and isolation experienced by those who have suffered so much over the past two years.
By eliminating the specialized MLTC plans that have sustained them during the pandemic, the state will inject new uncertainty and instability into the lives vulnerable adults and their families, and to the long-term care system that is fragile and frayed.
Given the significant risks to vulnerable individuals posed by this major shift in policy, one would expect its justification to be strong. However, its policy rationale is unclear at best. Disrupting the care that enables individuals to live independently in the community runs counter to the person-centered principles and health equity goals that the Hochul administration has championed.
This proposal is not sound, will destabilize services for vulnerable New Yorkers, and should be abandoned.
James W. Clyne is the president and CEO of LeadingAge New York an advocacy voice for not-for-profit and public providers of Long Term Care, including provider-sponsored Managed Long Term Care plans and programs.
