Actions in Albany Putting Seniors, Persons with HIV, in Harm’s Way

Next week Governor Paterson will convene a special session of the Legislature to address the state’s current budget shortfall.  There, he will promote his proposed 10 percent cut to Medicaid funds, which is one of several actions he is pursuing that will put frail seniors, persons living with HIV/AIDS and others with disabilities in harm’s way.

A little history and perspective:  Long-term care (nursing homes, home care and the like) has been especially hard hit by years of budget cuts.  Health care for frail older adults and others with disabilities has been cut six times already in the past three years.  According to the Continuing Care Leadership Coalition, which represents downstate care providers, these cuts have taken more than $2 billion out of our health care system.

In addition to across-the-board Medicaid cuts proposed in the Governor’s Deficit Reduction Plan, the Department of Health is moving forward with radical new Medicaid reimbursement methods for both nursing homes and home care that are based on regional averages.  These efforts are harmful to services for those who need them most.

These sweeping changes to Medicaid payments strike at the heart of long-term care providers that serve those with complex and multiple medical needs.  Many persons with limited resources who are living with HIV/AIDS, along with a number of frail seniors, need intensive services.  They are high users of Medicaid services, particularly home care.

In Village Care’s home care program, for example, about 1,500 individuals receive care each year, and a significant proportion of them require considerably more services than the “average” home care recipient.  

In fact, Village Care’s home health care program was established almost 20 years ago specifically to address the complicated care of persons with “special needs,” particularly those living with HIV/AIDS.

The new method of home care reimbursement that the state now wants to put into place would radically slash Medicaid payments to providers such as Village Care, who have sought to do the right thing by offering services to those with chronic, multiple conditions.

The state’s actions come in the self-described guise of “reform,” but they really represent an attack on those that have taken on the most challenging Medicaid beneficiaries – persons who have great difficulty functioning on their own at home.

These are persons who need ongoing medical care – including complicated AIDS treatment regimens – and who have considerable difficulties with what are called “activities of daily living,” such as bathing and dressing themselves.

Without intensive home care services, for example, many of these individuals would not be able to function alone and would be forced into more expensive care, such as a hospital or nursing home.

For Village Care’s home care program, for example, which provides vital services for those with “special needs,” the cuts would wipe out 40 percent of the program’s funding.  

Cuts such as that represent an abandonment of New York’s traditional commitment to serve the needs of those who simply don’t have the resources to fend for themselves.

Taken alone, the magnitude of the mid-year budget cuts proposed in the Governor’s plan is unprecedented.  But when you add in the impact that would come from the new reimbursement plans put forward by the Health Department, especially for home care, the impact is mind-boggling.

The strength of our long term care system and its very sustainability are at risk in the face of the Governor’s proposed Medicaid cuts, which exceed $300 million for New York’s nursing homes and home health care providers.

When combined with budget cuts that have already been implemented over the past three years – along with the radical new payment plans now on the table – these cuts would dangerously undermine long-term care in New York.  They threaten access to vital home and community-based services, they further destabilize nursing homes and they jeopardize jobs that are essential to local economies and critical to sustaining quality care for frail older adults, persons living with HIV/AIDS and other disabled New Yorkers.