There’s a potential storm brewing in New York state due to Gov. Kathy Hochul’s executive budget for 2025. The budget proposal includes over $1 billion in cuts to the states’ home care programs. The move is an effort to reduce Medicaid spending.
The budget proposal cuts, which was released on Jan. 16, would directly impact New York’s Consumer Directed Personal Assistance Program (CDPAP).
CDPAP is a state Medicaid program that allows people who need care, known as home care consumers, to hire the caregiver of their choice. This means the caregiver can be a friend or family member, and they receive compensation through the program. This program is popular in the state because of the autonomy it gives home care consumers.
The proposed budget cuts would also slash wages by $2.54 per hour for about 175,000 home care workers in New York.
“In a time where the need for home care is only growing, the choice to try to cut over a billion dollars from the program and literally remove people from care who need it, and lower wages for a workforce that it’s been consistently proven that increasing wages is what’s going to keep the program going, is absolutely and unstrategic and not in the best interest of New Yorkers,” Ilana Berger, the director of the New York Caring Majority, told Home Health Care News.
The move would also potentially prevent more than 100,000 people who rely on family members from accessing home care.
“For many people, a consumer-directed option is the only option because there are no agency workers in their region,” Berger said.
Plus, it would cut home care hours for up to 250,000 people by setting maximum home care hour limits.
This budget proposal comes at a time when New York is experiencing what Berger described as a dangerous home care worker shortage. Berger — who also serves as the New York director of Hand-in-Hand: The Domestic Employers Network — pointed out that 25% of New Yorkers will be 60 or older by 2030.
“That’s 5 million New Yorkers, and likely nearly a million will require home care by 2035 and we have the worst home care worker shortage in the country,” she said. “This is a time when we need to invest in the home care workforce, and in home care in general, to really build a robust and sustainable home care program to meet the growing need. We have 5 million New Yorkers over 60, we have 165,000 nursing home beds, and those are going away, so institutionalization is clearly not the solution.”
Kneecapping the CDPAP would also have an impact on New York’s home-based care providers, which serve as fiscal intermediaries.
There’s a provision in the budget proposal that prevents an entity that’s an existing licensed provider, or managed long-term care plan, from also being a fiscal intermediary for the consumer-directed program.
As a fiscal intermediary, AccentCare works with almost 500 Medicaid recipients, and employs over 700 personal assistants. The company has served as a fiscal intermediary for more than 19 years. The provision in the proposal would mean that AccentCare would have to forfeit this role.
“Severely limiting the number of [fiscal intermediaries] will cause not only access-to-care issues, but also limit a consumer’s choice on how they receive their care,” Joanna Ciampaglione, senior vice president and general manager of AccentCare Personal Care Services, told HHCN.
For now, New York has not passed its state budget for 2025. Last week, the state Senate and Assembly rejected the governor’s proposed cuts to the home care program.
“The Senate and Assembly in New York have each introduced their own versions of what the budget should be, and they have rejected these proposals,” Al Cardillo, president and CEO of the Home Care Association of New York State (HCA-NYS), told HHCN. “We fully anticipate that the governor’s office will be pushing to either get some of those accepted, or will be pushing for alternative reforms that put some additional cost and utilization controls on the system. What that will be and what it will look like, we don’t really know.”
Though this is a win for those who oppose the budget proposal, Cardillo pointed out that this is only phase one of the process.
“This has to continue to be taken with extreme seriousness,” he said. “Where it will land really depends on the legislature, and what the legislature is willing to entertain, given what will be an expected, very hard push from the executive in New York State for cuts and changes.”
Ultimately, organizations who oppose the budget proposal believe that there are other solutions that should be embraced in lieu of cuts to the program.
“The legislature just really needs to stand strong in opposing, obviously disastrous cuts, and supporting solutions that make a lot of sense like taking money back from insurance companies and reinvesting in home care,” Berger said. “The governor needs to realign her priorities and look at the facts, which is that the need for home care in New York State is only going to grow. You cannot cut your way out of that reality.”
To this end, the Home Care Savings & Reinvestment Act was introduced last year. If passed, the legislation would remove insurance companies from their role managing home care payments. It would also create a managed fee-for-service program.
“New York State has wasted nearly $6 billion in the past four years alone, paying these private insurance companies to mismanage our Medicaid home care, and we really get nothing in return,” Berger said. “It’s worsening the home care crisis for countless older adults and disabled New Yorkers.”
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