This comes after New York Gov. Kathy Hochul criticized the program, calling it “a racket,” telling Bloomberg News that it is “one of the most abused programs in the history of New York” as costs for the program have skyrocketed.

On July 2, the DOH announced that, “effective August 1, fiscal intermediary (FI) administrative payments will move to a non-risk distribution methodology for Medicaid Managed Care enrollees.”

The announcement emphasized upcoming changes, including the implementation of a three-tiered payment system for agencies that administer CDPAP based on the number of care hours completed monthly. Furthermore, reimbursements for direct care and administrative costs, typically paid at a single hourly rate, will now be split.

It is estimated that this could cut $200 million from state Medicaid payments to businesses that manage payroll and conduct administrative tasks for home health care aides and consumers. CDPAANYS said the cuts could result in lower wages and reduced access to care within the program.

Laura Cardwell, CDPAANYS’ director of operations and events, told Home Health Care News the proposed rates are “absolutely not sustainable, and that will become evident through the steps in the regulatory process.”

The DOH said it made the changes based on the Centers for Medicare & Medicaid Services’ (CMS) feedback and that “the new payment structure will be consistent with prior non-risk managed care payment arrangements, such as home and community-based service distributions.”

Still, those in the industry are concerned.

In a letter dated July 19, 2024, from the New York Health Plan Association, the Coalition of New York State Public Health Plans, the New York State Coalition of Managed Long-Term Care Plans, LeadingAge New York and the NYS Conference of Blue Cross Blue Shield Plans, who are not directly involved in the lawsuit, wrote, “It is worth noting that plans operate with an 89% medical loss ratio (MLR) – and rates are not supposed to be retroactively adjusted (in either direction). To the extent that plans have a surplus, funds will be recovered by the state through the MLR remittance process – making any additional premium reduction unreasonable and unnecessary at a time when plans must focus on implementing this significant policy change and minimizing member disruption.”

Home Care Association of New York State (HCA-NYS) CEO Al Cardillo told HHCN that they are highly concerned about the state’s actions in slashing the reimbursement of CDPAP.

“These cuts jeopardize the basic viability of care for this segment of the home care population and undermine the sustainability of the agencies essential for delivering the service,” he said. “Moreover, the cuts pile onto the already severe fragility of home care services access in New York state and will have the heaviest impact in the very geographic regions already suffering disproportionate home care loss due to underfunding. This policy flies in the face of the critical public need for home care and the role that home care fulfills as a core partner to hospitals and physicians in the continuum of care.”

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The Fair Pay for Home Care Act – which gained considerable traction in the state – seems to have hit a wall. And although higher home care worker wages are a part of the state’s recently finalized budget, it’s not what workers or providers were hoping for.

Firstly, the wage increases are relatively small. The minimum wage for home care workers will increase by $2 on Oct. 1, then will increase again by a dollar a year after that. 

The Fair Pay for Home Care Act also would have made wage increases commensurate with reimbursement increases for Medicaid-based home care providers. The state’s budget, on the other hand, does nothing to link increasing wages to Medicaid reimbursement.

“We remain concerned that the budget’s incremental increase of $3 an hour for home care workers over a two-year period – although a step in the right direction – may not be enough,” Kathy Febraio, the president and CEO of the New York State Association of Health Care Providers (HCP), said in a statement shared with Home Health Care News. “The budget did not address our core concern that any wage increase be fully funded with a linked Medicaid reimbursement rate for home care agencies. Our industry’s past experience with wage increases has shown repeatedly that this does not happen without it being required to happen.”

Providers have expressed similar sentiments in the past.

Although they are generally initially considered when it comes to mandated wage increases, they’re often left behind in final legislation, as HCP and other organizations fear they are now.

“When they introduce these kinds of bills, we always ask for a fiscal study on what it’s going to cost,” Darby Anderson, the chief strategy officer at Addus HomeCare Corporation (Nasdaq: ADUS), previously told HHCN. “Because they don’t factor in the Medicaid provider networks.”

Febraio also doesn’t believe that the home care wage increases will ultimately be competitive enough.

Providers, after all, are not losing workers to each other necessarily. Instead, they’re losing them to other industries, such as retail and fast food.

“New York’s statewide home care industry crisis continues, and this was the state’s opportunity to address it,” she said. “Home care wages need to be competitive and commensurate with the level of care and the skills demanded of these dedicated workers.”

There is also $1.2 billion dedicated to front-line health care worker bonuses in the budget, but HCP is additionally concerned that those won’t be available to home care workers. 

The Home Care Association of New York State (HCA-NYS) is likewise uneasy with the finalized budget and the effect it could have on the industry in the state.

“There remains a lot of uncertainty – particularly around whether and how the wage mandate will be funded, which has the potential to leave agencies in an extremely vulnerable position,” Alexandra Fitz Blais, the chief of external and strategic affairs for HCA-NYS, told HHCN. “We are obviously very grateful for the recognition and support of the legislature and the executive, but without adequate funding this could be devastating to the industry.”

All in all, the budget agreement includes a $20 billion “multi-year health care investment,” according to New York Gov. Kathy Hochul’s office. Included in that is the $1.2 billion of bonuses and $7.7 billion for home care worker increases, among other provisions.

Both HCP and HCA-NYS expressed gratitude for the policymakers that did bring home care to the forefront of conversations.

But at the end of the day, the industry doesn’t believe the state’s lawmakers – as a collective – came through.

“We are grateful to Sen. [Rachel] May, and Assemblyman [Richard] Gottfried, along with countless other legislators and advocates who did an extraordinary job bringing attention to in fighting for home care,” Febraio said. “[But] our industry cannot sustain wage increases without corresponding reimbursement increases. We will need to continue that fight in what remains of the legislative season.”

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The personal home care industry has received unprecedented recognition and praise over the last two years.

President Joe Biden and Vice President Kamala Harris explicitly mentioned home care – and home care workers – on the campaign trail and after inauguration.

“Just the fact that a sitting president is talking about home care is huge,” Vicki Hoak, the executive director of the Home Care Association of America (HCAOA), said during the Home Care Conference in December.

But it hasn’t just been the top politicians in the country bringing attention to the home care space. In fact, others have chosen actions, and not words, to show how much they value what the industry brings to the table.

Private equity firms and large health care systems – such as Advocate Aurora Health, which acquired the home care provider Seniors Helpers last year – have put significant capital behind some of the industry’s top providers.

Looking forward, there are a handful of factors that home care executives will need to key in on to not lose out on all the current opportunities. To help sort through those, Home Health Care News offers its top home care predictions for the coming 12 months below.

Curious what we predicted for last year? Revisit our 2021 predictions here.

HHCN published its home health predictions for 2022 in January.

Data will become increasingly important – and a great separator.

In 2019, on the brink of the pandemic, the Idaho-based market research and education firm Home Care Pulse released some troubling statistics on the state of data-tracking in the home care industry.

One example: 75% of agencies did not track readmission rates – at all.

Since then, there has undoubtedly been progress. But all progress is not equal. For instance, smaller agencies may have started tracking data for the first time, implementing something as simple as logging readmission rates through Excel spreadsheets.

But other agencies with extra capital – and more drive to begin partnerships with larger health plans and systems – have done far more.

For instance, BrightStar Care recently made what CEO Shelly Sun described as a “very large investment” into extracting data from its work. The company partnered with Avalere Health to conduct an analysis, which yielded various insights, including that BrightStar Care was saving “up to” $29,902 in total cost of care on a per patient basis.

Sun said the investment was well worth it because of what it would mean for future partnerships. BrightStar Care is working on hospital-at-home pilot programs with health systems already and looking to form even more partnerships with Medicare Advantage (MA) plans.

What this all will lead to is a bifurcation of the home care industry. More money to invest in data, along with better technology to track data and predict outcomes, could take the larger providers to another level and leave smaller providers – to a certain extent – behind.

Wage hikes could put home care providers in precarious positions.

It’s a near ubiquitous belief among home-based care providers that their workers deserve higher wages. The disconnect comes when the question of how to do that arises.

This disconnect is playing out in real time throughout the country and will likely continue to over the course of 2022. Part of what the brighter spotlight on home care brought, after all, was an increased recognition from policymakers and society at large that these workers were historically underpaid.

Bayada Home Health Care recently confirmed that it would be closing four of its personal care locations in Florida and laying off close to 700 employees in April due to “external factors.” Increased operational costs without increased reimbursement from Medicaid in the state, it seems, put Bayada in a tough position.

Meanwhile, the “Fair Pay For Home Care Act” has gained considerable steam in New York. The legislation, which would mandate wages for home care workers equal to at least 150% of applicable minimum wage laws, has been touted as a way to fix the worker shortage in the state.

But that’s a short-sighted view of the problem, some providers and advocacy organizations believe. Others, such as the New York State Association of Health Care Providers, support the state-level legislation.

“Our concern, and this is where we really diverge, is that whenever there have been these wage laws and requirements, the funding system has never actually followed through and compensated commensurate with what those obligations are,” Al Cardillo, the president and CEO of the Home Care Association of New York State (HCA-NYS), recently told HHCN.

On Jan. 1, 2022, minimum wages went up in 21 states, according to the Economic Policy Institute. The increases ranged from a $0.22 inflation adjustment in Michigan to a $1.50 per hour raise in Virginia, the equivalent of an annual increase ranging from $458 to $3,120 for a full-time, full-year minimum wage worker.

For private-pay providers, this is less of a concern – for now. As wages increase, naturally, the client cost in private pay will rise as well.

“We’ve always found ourselves in between trying to provide the best possible compensation for our employees at the lowest possible cost to the client,” Georgetown Home Care CEO John Bradshaw told HHCN last year. “But … those dynamics can get really out of whack.”

Many home care organizations have already had to raise their clients’ rates to help finance higher caregiver compensation. That includes some Griswold Home Care locations, though COO Steven Turner recently told HHCN the franchiser’s clients have been extremely understanding.

“We really haven’t had pushback on rate increases,” Turner explained at the Sales First Summit. “We’ve been forced to raise rates because we’re forced to pay materially more in some markets. At our national conference, I was doing an event, and I asked a whole bunch of owners, ‘How many of you have increased your rates in the last year?’ And every single person in the room raised their hand. I then said, ‘How many people have had pushback or complaints about it?’ No one raised their hand.”

Home care will have more representation on the public market.

It’s very likely the home care industry will have a new face representing it on the publicly traded market in the near-term future.

In June of last year, Bloomberg News reported that Help at Home was aiming to go public by the end of 2021. That did not come to fruition, but recent hires suggest that the move is coming soon.

Rounding out an almost completely new executive team, the company hired a new chief development officer in Rich Tinsley, along with Darren Lehrich as its new senior vice president of investor relations and finance. Lehrich has previously helped companies prepare for IPO filings.

But while Help at Home will likely have a stock ticker next to its name soon, don’t expect it to become a trend. While more home-based care companies are generally considering the private-to-public move, other home care companies are unlikely to follow.

After Aveanna (Nasdaq: AVAH) went public early on in 2021, BrightSpring Health Services filed the paperwork for a $100 million IPO. And though Help at Home should be next up, it’s more likely that it’ll be the one that caps off the wave of home-based care companies going public.

A few companies will blaze the trail for value-based care arrangements in home care.

Entering into value-based care and risk-sharing arrangements is not easy in home care. That’s partly because, unlike other types of senior care organizations, home care operators are often paid to keep a healthy person just that – healthy.

In these scenarios, re-hospitalization rates and “improvement scores” – two common value-based care KPIs – don’t always fit.

In some ways, the stars have to align: the right population to care for, in the right area, with the right two partners.

Nonetheless, home care providers recognize this as part of the future of health care, and thus, something they should be involved in. The companies that have dipped their toes in those waters will be the trailblazers, and everyone else will have the benefit of trying to follow their blueprints.

An example of this is the partnership between Anthem (NYSE: ANTM) and Care Advantage, which is a provider of personal care services in the Mid-Atlantic region.

Under the partnership, Care Advantage helps care for Anthem’s Medicaid long-term services and supports (LTSS) members in Virginia. While Care Advantage has been initially judged on just a few measures – such as ER usage, caregiver consistency and member satisfaction – it eventually wants to be exposed to all the risk that comes with caring for the population.

“It’s one gradual step,” Care Advantage CEO Tim Hanold previously told HHCN. “Then eventually, it’s about true value-based care, in which we want to share in risk and have skin in the game in regard to outcomes and members’ well-being.”

Another example is Addus’ (Nasdaq: ADUS) partnership with Presbyterian Health Plan, described as a “value-based post-acute care navigation agreement.”

Like the Care Advantage-Anthem partnership, it started with Addus taking on upside-only risk based on clinical measurements.

In due time, though, these providers – and many others that aren’t mentioned – want to have the ability to put their money where their mouth is.

Home care agencies will continue to face more regulatory hurdles.

A historically unregulated industry will have to grapple with more regulatory hurdles in 2022 than ever.

From Domestic Workers Bill of Rights policies, to standardization, to stronger unions, more regulation is undoubtedly coming.

Providers need to be cognizant, firstly, of the Domestic Workers Bill of Rights legislation, which is meant to extend workplace discrimination protections and establish wage standards. The legislation has not yet come to fruition, but will likely be resurfacing, Angelo Spinola, the co-chair of the home health and home care industry group at the law firm Polsinelli, recently told HHCN.

Along the same lines, unions – which have long fought to bring the mostly remote home care workforce together – have been emboldened by the COVID-19 pandemic. Legislation has been put forward in states like California, for example, that would allow home care workers’ contact information to become public, allowing access that’s critical to unionization.

While the idea of unionization in home care is complicated, and not a black-and-white proposition, unions would likely be at odds with providers in a slew of ways. Because unions have not been all that prevalent in the space in the past, new challenges will emerge.

Finally, there’s standardization. There are plenty of providers, especially the ones in states already standardized, that believe more broad-based regulation in the space would be beneficial.

Others operating in the 20 or so states that aren’t standardized may feel differently, however.

“Right now, every state does so differently. I think that’s a hindrance,” HCAOA’s Hoak told HHCN. “We want to talk about our industry across the country, but we really can’t because it’s so fragmented. You also can’t get data until you have standards for everyone to be on the same level.”

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While the rate for New York home-based care workers checked in at about 86% partially vaccinated and 71% fully vaccinated, at least 34,000 caregivers have not begun the process at all, according to reports from The New York Times.

The new data comes from preliminary reports from New York’s Department of Health. The department gathered this information by surveying licensed home care agencies in the state about vaccination levels among their workers.

Overall, the percentage of vaccinated home-based care workers is higher than expected but those who have missed the deadline are unable to continue working.

This means New York providers are moving to prevent a major loss of workers as a result, according to Al Cardillo, president of the Home Care Association of New York State (HCA-NYS).

“Agencies are trying to not fire people, even though the regulation says if you don’t comply, you’re to be terminated,” he told Home Health Care News. “They are trying everything from putting people on leave to things like PTO, but you can only sustain that for so long.”

Despite the organization’s support of universal vaccination across all home-based care, the mandate has received pushback from the HCA-NYS.

“We have been saying to our governor and our state health department, from the beginning, if you’re going to apply the mandate … you need to do it in a way that doesn’t cause a dislocation of care service for patients and a loss of workforce,” Cardillo said.

HCA-NYS is a state trade organization that represents nearly 400 home- and community-based care providers and organizations.

Further compounding workforce challenges, caregiver shortages exist in the field at “emergency levels,” according to Cardillo.

“You’re creating a huge cliff in the availability of services for vulnerable people,” he said.

HCA-NYS has urged state government officials to adopt a “phase-up” approach to the vaccine mandate.

“We’re not asking to delay the mandate, but implement it in a steady series of increments within the system,” Cardillo said. “It would be a phase-up, measured milestone trajectory for getting to the point where you’re reaching these broad public health vaccination goals. In the meantime, you’re not sacrificing huge chunks of availability of care services for people overnight.”

Cardillo noted that a phase-up approach would give home-based care providers time to determine the best mode of intervention for caregivers who have not yet been vaccinated.

For example, many providers have adapted the peer-to-peer method when it comes to engaging caregivers who may have vaccine hesitancy. The idea behind this approach is that the opportunity to learn more about the vaccine from industry peers can be effective.

“One of the more successful practices by agencies has been peer-to-peer support,” Cardillo said. “That might take a bit of time — four, five, six, or even seven one-on-one visits. That requires a runway. If we were under a phase-up timeline this would likely be at least one of the interventions agencies could try.”

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On Monday, the New York state budget was released, with the Health and Mental Hygiene bill published at the same time. The bill did not include the Fair Pay for Home Care Act, which calls for caregivers to be paid 112% of minimum wage or the applicable wage law in any given area.

The New York state legislature passed the final budget late Tuesday, leaving off the wage-mandate provisions in appropriations measures.

Separate from the Fair Pay for Home Care Act, the budget does include appropriations for investment in home- and community-based services using the increased share of federal FMAP funds, Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told Home Health Care News.

“The state opted to set aside a proposal for worker wage support, through an enhanced minimum wage mandate, for a variety of reasons, one of which is the long-term financial obligation of implementing a wage mandate,” Noyes said. “Some of those funds that would have been appropriated for that purpose are now being redirected along with other funds through the FMAP increase into a new purpose for home- and community-based services.”

Noyes noted that the exact target of those funds remains unknown at this time.

The budget gives the Cuomo administration considerable latitude in how those funds are to be expended at a future time.

“The fund leaves a lot of discretion for state agency commissioners to [use] those dollars through non-competitive contracts, grants or a number of other mechanisms,” he said. “Our understanding is that the funds are to be used for home- and community-based services with an eye toward worker supports. We’re going to be working very actively with the relevant agencies at the state level to advocate for an effective implementation method that benefits patients, workers and agencies, equitably across the system of services in New York state.”

In all likelihood, worker wages will remain at the forefront of the home care conversation, especially in New York, where home-based caregiving is one of the fastest-growing and largest workforces.

Like in nearly all U.S. states, the demand for caregivers exceeds the amount of available workers. On average, 17% of home care positions are currently left unfilled, according to data from the City University of New York.

Low wages play a role in the difficulty of filling these positions, as well as retaining workers. The median hourly income for a New York caregiver is $13.80, and the median annual income is $22,000.

Looking ahead, Noyes urges policymakers who are deciding what to do with these funds to consider the full scale of what’s needed to address a number of systemic needs in the home care space.

“A lot of pieces must come together to address some of the large-scale issues that we know need systemic support.”

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As of Wednesday afternoon, New York lawmakers were full-speed ahead on meeting their annual budget deadline of April 1. There is wiggle room for finalizing a budget after Thursday, but New York has not missed its normal target since the Cuomo administration took office.

“Everything’s very fluid right now,” Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told Home Health Care News. “The different conference committees are meeting to basically reconcile all these different proposals, with an eye towards finalizing the budget by the April 1 deadline, which is the statutory deadline for completing the budget and starting the next fiscal year in New York state.”

As it relates to the home-based care workforce, proposals include different plans to ultimately boost wages for caregivers.

Earlier this year, New York Sen. Rachel May sponsored standalone legislation — the Fair Pay for Home Care Act — requiring that home care aides get paid a wage that is 150% of minimum wage or the applicable wage law in any given area. Assembly Member Richard Gottfried sponsored the bill in his chamber.

“New York has been suffering with an austerity funding of human services, particularly health care, particularly home care, for years and years now,” Gottfried said in February. “It’s not just the COVID-19 recession that is causing this downsizing of funding. It’s a long-term problem.”

Now, lawmakers are attempting to boost home-based care workers’ wages through the budget process. Multiple options are being considered, according to Noyes.

One proposal is a scaled-down version of the Fair Pay for Home Care Act that would raise wages to 112% of minimum wage or applicable wage laws. Another proposal is a one-time bonus for in-home workers instead of an ongoing wage mandate.

“Negotiations are pretty feverish right now,” Noyes said. “We should know pretty soon what’s going to happen.”

Generally, New York’s in-home care providers are supportive of a wage hike for workers, many of whom are women, immigrants and people of color. Providers have urged lawmakers, though, to include long-term reimbursement support to help sustain higher wages for caregivers.

The 112% proposal only locks in one year of increased funding to pay workers. That lack of long-term, structural rate support for home-based care employers paired with an ongoing wage mandate could put them in a precarious position down the road.

“HCA has long supported reimbursement for enhanced direct-caregiver compensation,” the advocacy organization noted in a statement. “We appreciate the intent of new proposed state budget legislation to increase aide wages. However, the Senate’s one-house budget proposal would not sufficiently cover the full cost of this new mandate for home care provider employers in New York state, many of whom are operating at negative margins.”

Another downside to that proposal’s one-year funding plan is that it only supports Medicaid-reimbursed providers, leaving Medicare or private-pay employers to fend for themselves.

On its end, HCA has offered alternative budget legislation to the chairs of the state Senate and Assembly budget conference committees. Its proposal would provide a funding mechanism for wages and other supports for in-home care, assisted by federal aid and other sources for coverage of Medicaid and non-Medicaid services alike.

The bonus idea may win some supporters in the hours before the April 1 budget deadline because it meets the objective of getting funds out to caregivers directly without locking the state into a permanent obligation, sources told HHCN. It additionally avoids the potential political complications of implementing a new mandated minimum wage for a single category of worker.

A legal alert from Poricanin Law sent Wednesday afternoon reported that the Fair Pay for Home Care legislation “seems almost certain to become law.” If that proposal is enacted, providers would have to immediately raise pay for workers, as its provisions take effect on April 1.

“Such a quick effective date simply does not provide sufficient time for covered providers to actually come into compliance with the wage and benefit requirements of this legislation,” Poricanin Law’s alert stated.

Budget negotiations did not reach a conclusion at the time this story was published.

Broadly, home care is one of the fastest-growing sectors of the New York economy. In New York City, two out of every five new private-sector jobs in 2017 were in home care, according to state statistics.

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On Wednesday, the Home Care Association of New York State (HCA-NYS) released a report that explained how some of those specific cuts could be devastating to home-based care providers and why the budget should be revisited.

Cuts that would directly affect the home-based care industry include a 1% reduction for Medicaid providers, a 3.5% retroactive rate reduction to managed care plans and a 50% reduction in home care workforce recruitment and retention funding.

Less funding could not come at a worse time for the state’s home-based care providers. Even before the pandemic, 55% of all home care agencies in New York were estimated to have a negative operating margin, according to HCA-NYS.

That number has undoubtedly increased during the COVID-19 crisis, as agencies have seen a 136% increase in personal protective equipment (PPE) costs in addition to other expenses.

“Our goal has been to try to educate the state officials who are going to make decisions in the budget process on this role that we play,” Al Cardillo, president and CEO of HCA-NYS, told Home Health Care News. “We’re calling on legislators to reject these cuts in our field, because not only are you going to have an adverse effect on those you are caring for, but you’re going to cripple the very part of the system that is needed desperately during COVID.”

HCA-NYS has nearly 400 provider and organization members that deliver home- and community-based care to hundreds of thousands of New Yorkers annually.

The staffing environment is already turbulent in home-based care. That’s why the 50% reduction to home care recruitment and retention funding would hit especially hard.

Last year was the first year of decline in home health aide employment following a six-year period of growth in New York.

Overall, 85% of home care agencies in New York report that existing structural workforce shortages have been “greatly amplified by COVID-19,” according to HCA-NYS. About 44% of home care and hospice agencies have experienced a decrease of 11% or more in their home health aide and personal care aide workforce capacity since March 7, 2020, when the public health emergency was declared.

“We’re really presenting the fact that home care is, to a great extent, the solution that keeps the system going,” Cardillo said. “You don’t want to trip up the very thing that’s maintaining your health care system.”

The struggle that New York providers are already facing is reflected in the numbers.

One-third of them have relied on Paycheck Protection Program (PPP) funds to meet payroll. Additionally most agencies are relying on some form of money borrowing to stay afloat, according to HCA-NYS’s report.

As of July 2020, at least 458 in-home care businesses in New York had received nearly $18 million in PPP loans of under $150,000, a HHCN review of federal data found.

That’s why HCA-NYS is not just asking for the cuts to be done away with. The association is also hoping for things like PPE costs to be baked into reimbursement moving forward.

“It’s something that should be built into the system so that when those costs are incurred and necessary, they’re in there,” Cardillo said. “They’re reflected in the rate so that providers can have the proper stockpiles and proper preventive protocols that are financed. It shouldn’t be something that you’re scrambling for and then two years later, you’re restoring it in a rate adjustment — it’s got to be real time.”

Money coming in

There is still a chance that through advocacy efforts and other funding measures, those cuts to home-based care could be mitigated.

For one, on a federal level, House lawmakers included a 7.35% Medicaid boost for home- and community-based services in the stimulus proposal making its way through Congress.

In addition, the original budget proposal had the worst-case scenario in terms of budget relief from the federal government in mind. Instead of just $6 billion in relief, New York could be getting as much as $12 billion.

With a $15 billion budget deficit, fewer cuts would need to be made.

“We’re obviously urging that the anticipated increase in federal aid to the state be utilized to turn back those cuts,” Cardillo said. “But also, we’re hoping that aid that’s specifically directed toward COVID relief should also be fairly and proportionately directed to the home- and community-based system.”

Thus far, much of the COVID-19 relief money has not been directly set aside to aid home- and community-based services.

HCA-NYS is also asking for more information from the state legislators. Since the onset of the pandemic, home-based care providers have fulfilled reporting requirements and surveys on a day-to-day basis, but have not received any beneficial data back in return.

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Specifically, the proposed budget would mean a 50% reduction in home care workforce recruitment and retention funding, as well as a 1% reduction for Medicaid providers and a retroactive 3.5% rate reduction to managed care plans.

Total federal, state and local Medicaid spending under the state budget proposal is expected to be $82.9 billion in 2022. That includes $48.1 billion in federal spending and $27.6 billion in state spending.

The 50% reduction in workforce funding would claw back more than $22 million in 2022 and 2023.

Budget cuts are hard to avoid for states that are dealing with significant deficits tied to the COVID-19 crisis, among other things. But it is unfortunate that the cuts would affect an industry that is dealing with the virus head on, critics note.

On its end, New York is facing an unprecedented budget deficit of $15 billion. The state is worried the federal government will at least cover $6 billion of that, knowing it will have to make up the rest of the deficit internally.

New York’s cuts to health care funding will only be revisited if the money from the federal government comes in higher than expected. The budget will be finalized on April 1.

“The governor of New York state has not been shy about stating that, unless there is a major federal bailout, New York state will be forced to make significant cuts to, among other [areas], community-based services,” Emina Poricanin, managing attorney of Poricanin Law, told Home Health Care News in an email. “The proposed budget cuts are a reflection of the governor’s fear that he will have to impose cuts in some areas in order to balance the budget.”

The 1% Medicaid cut would be across the board to all providers. The 3.5% cut to managed care plans is also a concern because those plans may pass losses down to the providers.

The home care workforce recruitment and retention funding is usually earmarked to supplement the wages of home care workers. The budget proposal, if finalized, could cut the critical fund in half.

While the state is in dire need of cuts, it doesn’t necessarily excuse the specific cuts related to home- and community-based care, Roger Noyes, the director of communications at the Home Care Association of New York State (HCA-NYS), told HHCN.

“Just because the budget calls for cuts doesn’t mean that these cuts aren’t counterintuitive,” Noyes said. “In fact, they would have a harmful impact at a time when COVID-19 has affected providers, services and the workforce.”

Especially with how tough the staffing environment has been for the home-based care world, even before COVID-19, the cuts to recruitment and retention funding would hit hard.

“At the same time, we understand that there are those types of decisions that need to be made given the budget deficit we’re facing,” Noyes said.

HCA-NYS has been working aggressively to help mitigate any harm that budget cuts could cause in New York. But because the deficit is so dire in its state, the association has turned its eyes to the federal level.

After all, if New York gets more monetary assistance from the government, Gov. Cuomo is less likely to implement cuts on health care providers.

“We’ve been working as aggressively as we can with state officials and with our congressional delegation to send that message to Congress,” Noyes said. “That without the funding at a level that can cover the impact of COVID on state finances, you’re putting a workforce in harm’s way that’s needed at this very moment when we’re in a crisis.”

Additional funding from the government could help the situation in New York and other states in similar scenarios, however.

The House Energy and Commerce Committee proposed some major Medicaid provisions to the $1.9 trillion relief package making its way through Congress. If enacted, the measures would benefit home-based care providers across the country during the public health emergency.

The draft legislation would give a 7.35% rate bump for states to specifically enhance home- and community-based services (HCBS).

It could be worse

There was a pleasant surprise in the House bill, the most recent version of the new spending package. The Biden administration’s plan would give New York around $12 billion instead of $6 billion.

That would roughly mean that New York only needed to make cuts to cover $3 billion in deficits — and not $9 billion. It is far from a done deal, but Noyes called that update “very promising.”

Also, while home-based care could experience damaging cuts, there was always a chance it could be targeted even more.

“Contrary to previous years, there was relatively little in the budget about home care specifically,” Poricanin said. “Therefore, while some reimbursement cuts are probable, providers are also relieved to know that, unlike previous budget years, their industry is not being targeted significantly.”

Also included in Gov. Cuomo’s budget proposal was a plan for the extensive expansion of telehealth.

There’s not a lot of details as to what that means yet, but it could be an encouraging sign for providers, if done the right way, Noyes said.

“The governor has really put telehealth on the map with this budget,” he said. “We’re looking at that closely. But we do have questions as well as some concerns about it. Because we want to make sure that it equitably treats home- and community-based care. There’s also questions about how, as you open up telehealth more, you ensure quality standards and some of the existing jurisdictional boundaries that exist between different settings for care.”

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The New York State Department of Health originally announced that home care and hospice workers would be eligible to receive the first dose of the vaccine starting on Jan. 11. This placed these individuals in the Week 5 group of the state vaccination program.

The department updated that plan last Monday, moving home care and hospice workers to the Week 4 group receiving the vaccine starting on Jan. 4. 

This development didn’t just happen overnight. In fact, it was the result of a significant push from New York home-based care associations, Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told Home Health Care News.

“I would say that is a huge development, and it’s something that we’ve been pushing for several weeks to ensure that there was a prioritization in Phase 1A for home care and hospice workers,” he said. “It took a lot of conversations with the state department of health and the city department of health.”

HCA-NYS is a state trade organization that represents nearly 400 home- and community-based care providers and organizations.

Noyes noted that — because of the infrastructure currently in place, which involves the 10 regional hubs of New York overseeing the vaccination system — the distribution-planning process involved multiple conversations with various agencies and players. 

Home Healthcare Workers of America was also part of the overall advocacy push. The organization, which represents over 26,000 in-home care workers, saw firsthand the need for urgency when it comes to vaccination.

“During this time, tragically, we have lost 12 aides from the start of this to the present,” Joe Pecora Jr., the organization’s vice president, told HHCN. “Our members were desperately asking for access to the vaccine. We’re happy that the governor’s office and the department of health have agreed to move up their eligibility. This is a lifeline.”

New York state employs more than 210,000 home care aides, labor statistics show.

Home Healthcare Workers of America is a part of the International Union of Journeymen and Allied Trades (IUJAT). The organization represents workers primarily located in the five boroughs of New York City.

Throughout the COVID-19 emergency, visibility has been a major challenge for home-based care organizations. At times, this resulted in these organizations being overlooked.

Being prioritized for vaccine eligibility represents a shift, according to Noyes.

“Whether it was [personal protective equipment] status or authorization to visit patients in their own homes when there were travel restrictions in place, this has been an issue,” he said. “To now have, at this pivotal stage of the vaccination rollout, home care and hospice workers in early, that is an important accomplishment.”

For now, HCA-NYS has been keeping its members updated on the logistics and procedures for actually getting the vaccine.

It’s a process that has run the gamut, according to Noyes.

“For instance, some agencies, I understand, have ordered the vaccine, and I don’t know whether they’ve received it yet, but they have plans to vaccinate their own staff — to actually have their own agency be the point of dispensing a vaccine for their workers,” he said.

Meanwhile, other agencies have opted to instruct their staff to essentially make their own appointments with the various dispensing hubs that are being set up across the state.

In these cases, HCA-NYS has provided instructions around what information workers need to bring to these appointments in order to prove they’re Phase 1A. Similarly, it has helped its members understand what documentation they need to retrieve from the vaccination site.

So far, New York City’s mass vaccination efforts have gotten off to a rough start.

Despite a surge of new COVID-19 cases, few people have been vaccinated. This has left public health experts concerned, according to reports from The New York Times.

Overall, only 167,949 of 489,325 doses of the vaccine — roughly 34% — have been administered as of Friday. The rate for New York state overall is over 40%, according to The New York Times.

The vaccination rollout potentially creating hiccups that would impact home care and hospice workers is a concern, according to Noyes.

“Home care and hospice workers are now in priority 1A,” he said. “But if there’s concern that the vaccine is not being administered to health care workers at the rate it should be because of hesitancy, … then there’s going to be a big impetus to push through to the other phases. Certainly, there are other priority groups that need the vaccine quickly, but my concern is whether or not this push could squeeze out access for home care and hospice workers.”

Elsewhere, early last week Los Angeles County’s home care companies received confirmation that non-medical caregivers are part of the first group eligible for vaccination.

Prior to this confirmation, home care companies weren’t clear on whether their employees were part of this group, which includes their home health counterparts.

Home health leaders and clinicians in various parts of the country have also begun to highlight their vaccine experiences on social media. That group includes Dr. Steve Landers, president and CEO of the Visiting Nurse Association Health Group Inc.

Senior living operators have ramped up their vaccination efforts as well.

On Dec. 21, for example, Brookdale Senior Living Inc. (NYSE: BKD) announced it had held its first community vaccine clinics, with plans to schedule more across the company’s 726 communities.

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And while every home-based care provider and worker keeps reading that the vaccines — both Pfizer’s (NYSE: PFE) and now Moderna’s (Nasdaq: MRNA) — are here, they’re wondering where.

Vice President Mike Pence and his wife, Karen Pence, were both vaccinated on video Friday. Senate Majority Leader Mitch McConnell (R-Ky.) tweeted out a picture of himself post-vaccination as well. Hospital workers have danced on TikTok celebrating the Pfizer-BioNTech vaccine’s arrival at the Boston Medical Center.

But for the home-based care world, key information regarding the vaccines is still hard to find.

“We don’t know not only when but where,” David Totaro, the chairman of the Partnership for Medicaid Home-Based Care (PMHC), told The Philadelphia Inquirer last week. “We don’t even know how we’re going to be notified.”

Over the last week, most of the major home-based care trade organizations have released guidance for providers on how to handle vaccinations in the workplace.

Home-based care workers have been labeled 1a — or highest priority — to receive the vaccine in most states.

The National Association of Home Care & Hospice (NAHC), for instance, is telling providers to “encourage all home care and hospice staff to receive a COVID-19 vaccination at the earliest possible time consistent with vaccine guidance.”

The national association suggests providing the support necessary to help workers gain access to the vaccine as soon as possible as well as access to comprehensive and fact-based information regarding immunization. It also reiterated the importance in following safe protocols throughout the pandemic in the meantime.

The Home Care Association of New York State released similar guidance, and the National Hospice and Palliative Care Organization (NHPCO) released a statement of its own.

“Hospice and palliative care professionals are on the front lines of health care delivery in this country. Not only are they serving the most vulnerable population with complex medical needs, but they are caring for people in their homes, interacting with family caregivers, and traveling throughout the communities they serve,” NHPCO President and CEO Edo Banach said. “For their own protection, the safety of those under their care, and the welfare of their families and communities, NHPCO encourages these dedicated professionals to receive the COVID-19 vaccine.”

Each state’s plan to roll out the vaccine is different, so organizations that work in multiple states will have to do their due diligence in each region to ensure that their workers have access to one of the two vaccines as soon as possible.

Still, the home-based care organizations stopped short of encouraging mandatory vaccinations for workers, despite their assurance that immunization will be safe and effective in stopping the spread of COVID-19.

“The next thing that we’re trying to address right now is whether or not vaccines should be mandatory among our staff,” Totaro said during Home Health Care News’ Capital+Strategy event earlier this month. “And that’s a very, very complex issue. We’re taking it very seriously.”

San Francisco-based law firm Littler Mendelson released a client alert to home-based care organizations this week regarding that issue.

For many reasons, Littler is urging providers to wait before taking a firm position on mandatory vaccinations for workers.

“Employers really cannot make vaccinations completely mandatory,” Angelo Spinola, a shareholder at Littler Mendelson, wrote. “They must always allow exceptions based on health and religious beliefs.”

Spinola urged home-based care clients to consider a handful of questions: Firstly, are there exclusions regarding who should receive the vaccination, from a medical perspective?; Will there be side effects to the vaccine that could hurt employees?; Are your employees reticent or or enthusiastic about the vaccine?; And how are others in the industry responding?

Those questions all suggest that providers should wait before making the call. In some states, health care workers are required by the government to receive flu shots, for instance. If the government could make vaccines mandatory, Spinola urges providers to let lamakers do it first.

Plus, there are other things to consider.

“Mandatory vaccinations may lead to potential workers’ compensation claims from employees who suffer an adverse reaction to a potential vaccine,” he wrote.

In any case, encouraging vaccination, but stopping short of mandating them, seems to be the resounding guidance right now from industry insiders.

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