When Gov. Kathy Hochul delivered her budget address, she warned that some lawmakers would be displeased with her revisions to the state's Medicaid program, or a $1.2 billion reduction in support for long-term care, home care and staff wages, and see the changes as cuts — and she was right.
Hochul's budget reduces $400 million to long-term care services, but the state Health Department and stakeholders will identify the specifics of where as budget talks continue. Hochul's spending plan also discontinues wage parity within Medicaid's Consumer Directed Personal Assistance Program to save about $200 million, and a smattering of other smaller changes, including a $75 million cut in funding for distressed nursing homes and $23 million less in capital funding in those facilities.
Assembly Health Committee chair Amy Paulin said Wednesday she does not understand some of the Medicaid changes proposed in the governor's budget.
She wants more specifics on why, and how, the governor's plan includes cuts to nursing homes, health and home care wages.
"That's the group of workers that were cut, and it's a significant cut, so we don't understand exactly what they're doing there," the assemblywoman said.
Paulin, a Democrat from Scarsdale, hopes for more clarity in the 30-day budget amendments, and is looking to Tuesday's health budget hearing to best direct the Legislature as budget negotiations begin.
"Home care is cut, health care wages are cut, it looks like," Paulin said. "More specificity is needed as to exactly why, and how."
Hochul on Tuesday discussed the need to revise the state's Medicaid program after it's grown nearly 40% over the last three years. She said the state must prevent deeper financial hardships in the future, with a $5 billion deficit expected in two years.
"The truth is, sizable deficits are projected in coming years," Hochul said during her budget address. "And our discipline now will keep us out of a deeper hole in the future."
Nursing homes, long-term care and health providers want the Legislature to go to bat for them this budget cycle and undo Hochul's proposed Medicaid revisions in the Senate and Assembly's counter proposals released in March.
They say Hochul's $1.2 billion reduction in areas of Medicaid will impact New Yorkers' access to care if it makes the final budget due April 1. Medicaid typically serves low-income and disadvantaged populations.
"AARP believes that the governor's long-term care policy both for Medicaid and non-Medicaid needs to be flipped," said Bill Ferris, a representative with AARP New York. "It's not addressing the needs of older persons in New York and their family caregivers."
Ferris says AARP will push the Legislature to restore the millions of dollars removed from the Medicaid long-term care program, and advocate for $45 million for the state Office for the Aging to aid caregivers.
Lawmakers and advocates held several rallies in the Capitol on Wednesday detailing what they dislike about the governor's $233 billion executive budget proposal, with nursing homes and long-term care providers upset about Hochul's plans for Medicaid as New York's program continues rapid growth.
Nursing homes and lawmakers have fought for years to increase the state's Medicaid reimbursement rates for adult care, and rebase, or recalculate, its rates.
Many stood with lawmakers Wednesday frustrated over the Medicaid changes in Hochul's budget they say fails long-term care, and New York's increasing aging population.
"The upstate issue is where we are truly feeling it again with the hundreds of beds that are empty in our nursing homes," Assemblywoman Pat Fahy said. "We are in a crisis."
They want a 16% increase to its reimbursement rates for adult care to improve staffing for empty beds waiting to be filled.
"Communities will not have their local not for profit nursing homes anymore — they simply won't," said Andrew Cruikshank, CEO of Fort Hudson Health System Inc.
The Fort Hudson Health System, based in Glens Falls, Warren County, has 196 beds over four types of nursing centers. Upward of 30 beds have been kept offline in the last two years because the facilities lack about 40 staff members to keep them all open, Cruikshank said.
But lawmakers and providers argue the Medicaid changes don't make sense as the state will get $6 billion from a federal waiver to improve health care equity, and say will make it harder for providers and health plans to implement.
"These cuts will make it difficult to make those investments, and we hope that the Legislature rejects these proposals and restores these cuts," NY Health Plan Association President & CEO Eric Linzer said Wednesday.
Every member of the Legislature is up for election this year, but the governor is not, which could create a tense power dynamic during budget negotiations when it comes to health spending — one of the most expensive parts of the budget.