Scope and Scale of State Budget Cuts Raises Equity Issues

Scope and Scale of State Budget Cuts Raises Equity Issues

The state’s fiscal woes cannot – and should not – be fixed on the backs of the poor.

That’s exactly what will happen, though, if significant Medicaid cuts are enacted, cuts that would drive an immense hole through the budgets of those who provide essential care for older adults, persons living with HIV/AIDS, low-income children and disabled individuals.

Yes, everyone – all sectors – needs to share in bringing the state’s fiscal imbalance under control.  But ripping out the core of society’s health safety net here in New York brings forth the specter of inequity such that we have not seen before.

To create a situation where pieces of that safety net will surely be lost is more than a straying from enlightened policy.  It is an abandonment of those who have no where else to turn.

At Village Care of New York, we provide care and services for as many as 5,000 people each year.  For many, we’re talking about skilled nursing care either at home or in a nursing home – and we’re talking about services that help prevent people from having to go into institutional care.

At Village Nursing Home, for example, up to 90 percent of the budget is paid for by Medicaid funds we receive through the state Health Department, most of which is used to cover labor costs.  Similarly, our Rivington House, the premier residential AIDS facility, which is almost wholly funded by Medicaid, likely would face significant staffing reductions in the face of massive Medicaid cuts.

Efforts to keep people in their homes safely would suffer – with our own Certified Home Health Agency and Village Care Plus, a licensed home care agency, likely having to cut back staffing in a major way also.  This would mean fewer visits, and fewer people with access to care.   The existence of our day health centers for seniors and for those who are HIV positive would be threatened, as would transportation services for frail elderly.  

Those are the kinds of services that help people continue to live in the community.  Think about this:  The proposed state budget would take away the services that help people live at home, and at the same time create greater pressures on institutional care options.  Even if people can get into residential care, the budget raises serious questions about the quality of care they would receive because of the staffing shortfalls that would be forced to occur.

Cutting Medicaid is a solution to our fiscal woes that doesn’t work from a human rights standpoint, or from a financial perspective either – for every dollar in its Medicaid budget that New York cuts, it loses two dollars in federal funds.

It doesn’t have to be this way.

We can see our way through this economic and fiscal crisis without tearing the heart out of New York’s safety net programs.

First, we need to spread efforts to save money across all sectors of government so that we can assure that health and long-term care for our vulnerable citizens can be protected.

And, more importantly, we’re going to have to raise taxes on the richest of New Yorkers, who are in the best position to contribute to rescuing our safety net programs and services.

There needs to be an economic stimulus program from Congress, which President-elect Obama supports, to bring an infusion of cash into New York’s health and long-term care system to help see it through these difficult times.  New York governmental and legislative leaders furthermore must pledge to use these relief funds directly for the Medicaid population for which such monies would be intended.

If we don’t do this, we will bring upon us here in New York a new dark age where older adults and those with disabilities and HIV, who rely on Medicaid and other governmental entitlements, are largely abandoned.  

Access to care will be riven:  Some will get services.  Some won’t.  Some will get good care.  For others, care will be substandard.

For nursing homes, we will return to what we thought was a bygone era, where such care was disgracefully doled out in overcrowded and understaffed homes, and where there were no other choices.