State adds flexibility to Medicaid payment plan

Program that provides payments to disabled to continue amid overhaul

Efforts made to ensure Consumer Directed Personal Assistance Program consumers won’t be negatively impacted.

The state has inserted some flexibility in its plan to consolidate hundreds of non-profits that route Medicaid payments to caretakers of more 70,000 elderly and disabled New Yorkers.

As initially proposed by Gov. Andrew M. Cuomo’s administration, the enacted 2020 state budget will cut $75 million from the Consumer Directed Personal Assistance Program. But new language ensures that “fiscal intermediaries” that registered with the state before 2012 will continue to process payments, while hundreds of other programs will have an avenue to re-register or transfer their consumers to another organization.

The final spending plan also creates an appointed panel of stakeholders to ensure that the overhaul is conducted in a way that does not negatively impact CDPAP consumers’ choices, geographic availability, or cultural competency, according to Freeman Klopott a spokesman for the state Division of Budget.

“These consumers will continue to receive services as they do today without any reduction in care, with no change in cost, and the program will continue to be available as it is today to new consumers,” Klopott said. “The changes are simply designed to promote efficiencies in the administration of the program.”

The final budget does not set a specific limit on the number of organizations that can pro

vide fiscal intermediary services. Rather, the Department of Health will determine the number of entities based on criterion produced by the working group.

Assemblywoman Melissa Miller, R-long Island, whose 19-year-old son Oliver has developmental disabilities and will be eligible for the program when he turns 21, has been pushing back against the cuts, noting that the lack of oversight in the program is partially a result of the speedy implementation and expansion of the program.

In the 1999 decision, the U.S. Supreme Court ruled that according to the Americans With Disabilities Act, states have an obligation to provide services to individuals with disabilities in the most integrated setting possible.

In compliance with that decision, the state aggressively moved towards integration for people with special needs, and many institutions were shuttered. The CDPAP program was created to close the gap for people with higher needs, enabling them to remain in their homes with the caretaker of their choosing, often a family member.

The program was so popular and the need so great in New York that there were not enough intermediaries, Miller said. By 2012, “the state was begging agencies to please open.”

The rapid proliferation of programs resulted in haphazard arrangements and poor monitoring of the community organizations. A 2018 audit of the CDPAP program by the state inspector general’s office determined that during a four-year period, the state had been overpaid $74.8 million in Medicaid disbursements associated with the program.

At the end of March, the state quietly altered the CDPAP pay structure, limiting the number of hours that fiscal intermediaries can bill per consumer each month, a change that is projected to save the state $14 million, according to Miller. It’s not clear where the remaining $60 million in cuts would be applied or how the state would prevent those cuts from being passed on to consumers.

“Were there mistakes made? Were there bad actors among the fiscal intermediaries? Absolutely,” Miller said. “But then oversee it, don’t defund it and punish the people that depend on it.”

Health law attorney and lobbyist Mark Ustin noted that the governor and Legislature are increasingly relying on blue-ribbon panels to make recommendations on difficult issues. If done right, the working groups can help ensure stakeholders buy in.

If done wrong, it may be “kicking the can down the road to a time when it won’t be any easier to make the hard decisions,” Ustin said.