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Medicaid reform on the horizon

Press and Sun article .pdf – Written by Jennifer Micale – 8:36 PM, Jul. 30, 2011

Medicaid Reform in NYS reported that Gov. Andrew Cuomo is working to reform Medicaid, the program developmentally disabled people and their families rely on to pay for most of their care.

As the state Office for People with Developmental Disabilities (OPWDD) works to overhaul its current service structure, the system is in a state of flux.

OPWDD’s budget provides $4.3 billion to support state and non-profit operated programs for 2011-12, including about 39,000 community residential placement spots. That number is up 200 from the previous budget year because of continued efforts to transition people in institutions into more appropriate community placements, said agency spokeswoman Nicole A. Weinstein.

The budget reforms the financing of many OPWDD programs and services, and expands less-costly day and residential programs by 2,400 spots. At the same time, it reduces funding for local programs, which are primarily run by nonprofits, by 2.8 percent, or $63 million. However, Weinstein notes that’s still $20 million more for local programs than was budgeted in 2009-2010.

Non-profit and state agencies who care for the disabled are considering how they’ll cope with their reduced funding.

Caring for the disabled can be costly.

“New York State’s cost per person, per day in Developmental Centers is $1,220; the average cost to run a State-operated individual residential alternative in Broome County that offers 24/7 supervised care is $227,000 per person, per year,” Weinstein explained.

Some severely disabled people require one-on-one supervision — sometimes more — and others require physical or occupational therapy or other supports.

“They’re asking us how you’re going to take your cut,” said Stephen Sano, executive director of the Handicapped Children’s Association (HCA). “What do you want us to do, heat on the odd days? Stop serving dinner?”

ACHIEVE Executive Director Mary Jo Thorn said her agency was expecting to lose at least $110,000 through reduced funding, which could hit programs that give the disabled somewhere productive to spend their waking hours — such as day habilitation and pre-vocational training — as well as equipment purchases.

There is some money available, such as for supported apartments and intensive behavioral services, Sano noted. The idea is to keep individuals with their families until the state makes it through the budget crunch, or a crisis intervenes. Once that’s over, more group homes may be on the horizon again, at least in theory.

Care for the developmentally disabled, and the funding mechanisms behind it, are expected to change significantly with the 1115 Medicaid waiver, now under development by the OPWDD and state Department of Health.

Dubbed “People First,” the waiver is intended to lower health care costs for the 100,000 developmentally disabled residents enrolled in Medicaid, according to the National Association of State Directors of Developmental Disabilities. Eighty percent of them have been assessed as needing an institutional level of care, either through an intermediate care facility (ICF) or a nursing home.

During the first five years the waiver takes effect, the state plans to create community services for the 275 people now housed in four developmental centers, including Broome, who don’t have specialized treatment needs. There are also preliminary plans to reduce the institutional population at state institutions to 300 over the five-year period from the 1,260 there now, according to the federal Centers for Medicare and Medicaid Services.

When it comes to funding, the waiver also would end the fee-for-service reimbursement system, and the state will work with CMS in the waiver’s first year to ensure that per diem rates for group homes more closely reflect the actual cost of providing services, according to the association.

Community providers won’t know the specifics until next year, Thorn said.