Here’s How Proposed Medicaid Cuts Will Affect Your Child with Special Needs

Governor Andrew Cuomo’s Medicaid Redesign Team II has proposed $2.5 billion in cuts to the state’s Medicaid program that will affect many consumers as New York moves into a managed care model from a fee-for-service model. The cuts passed on March 19. Activating the changes, which would have occurred regardless of the pandemic, has been postponed; $400 million is set to be cut this year after the emergency ends.

Hospitals, medical homes, chronic disease management, and maternal care are just some of the areas that will be impacted. Long-term care, including personal care and consumer directed personal care services, which children with special needs often require, will be impacted as well. Long-term care is growing faster than the rate of inflation and is the single largest cause of the state’s Medicaid deficit, according to MRT II’s proposal. Here is how these proposed cuts and changes will affect your child or adult child with special needs (“the consumer”):

• The 60-month look-back period, previously used for people seeking Medicaid eligibility for nursing home care, will now be applied to consumers seeking home and community-based services.
• Parents living with their children can no longer refuse to make their income and resources available during the child’s Medicaid eligibility determination period.
• In order to be eligible for personal care or consumer directed personal assistance, your child must now be determined to need assistance with more than two activities of daily living.
• Changes will be made to the way local social service departments administer personal care and Consumer Directed Personal Assistance Program services to generate savings, including:
  • An “independent clinician panel” will now assess consumers and order services.
  • The utilization review process, which assesses how consumers use their services, will be enhanced for individuals who are assessed to need more than 12 hours of assistance per day on average in a given month, to make sure it is safe for these individuals to remain in their communities.
  • Community Health Assessments, which used to be administered every six months, will now be conducted annually unless the patient’s condition destabilizes
  • A “uniform taking tool” will now be used to determine service utilization, including the hours of personal care or CDPAP a child needs per day.
  • The provider “choice” model will now be used for electronic visit verification, in accordance with the Federal 21st Century Cures Act.
• CDPAP-specific reforms, discussed by the Long-Term Care Advisory Group, include and are not limited to:
  • The number of fiscal intermediaries that deliver services will be streamlined through the Request for Offer process.
  • Families must work with a single fiscal intermediary for CDPAP.
  • Personal care assistants can now transport consumers during approved hours.
  • Standards and protocols will be developed to determine whether consumers are self-directed.
• The reforms have also proposed limitations to the number of licensed home care services agencies that are authorized to participate in the state’s Medicaid program; the evaluation criteria for selecting LHCSA's would establish a baseline for wages paid to home health aides and personal care workers employed by licensed home care services agencies as well.
• All Community Health Assessments and reassessments will be completed by a single, statewide Independent Assessor
• The state will offer non-Medicaid long-term care programs—in other words, a private pay personal care service option—supported by a New York State of Health Marketplace, where you could purchase pre-negotiated, pre-priced personal care packages from LHCSAs for your child or adult child.

You can learn more about the opportunities programs like CDPAP and Life Plans could afford your child with special needs before reading the full MRT II proposal on the Department of Health website.