CDANY 2024 Part HH Opposition Letter 
We invite your organization to sign the opposition letter below to Part HH of the 30-day amendments to the Governor's budget proposal. Part HH contains several harmful changes to CDPA, including the elimination of designated representatives and a repeal of the RFO, which will remove access to CDPA for at least a third of consumers and give sole contracting power to the Commissioner of DOH

Please fill out this form by 3 PM on Thursday, February 29 if you would like your organization included, and send any questions to Julia Battista at Consumer Directed Action of New York (CDANY), julia@cdpaanys.org.
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We, the undersigned organizations, strongly oppose  the Governor’s budget proposals regarding Consumer Directed Personal Assistance (CDPA), including the elimination of wage parity and Part HH of the 30-day amendments. The proposed changes would undermine the integrity of a program used by more than 250,000 disabled and older Medicaid consumers, allowing them to live at home and be active members of their communities.      

  • We strongly oppose the elimination of wage parity for CDPA only. Wage parity requires fiscal intermediaries, licensed home care services agencies (LHCSAs), and others in the home care space to provide an additional $2.54/hour in wages and benefits to personal assistants and personal care aides in New York City, and an additional $1.66/hour in Long Island and Westchester. Removing these supplements for CDPA only would not only lower the total compensation for CDPA to levels not seen since 2018, it would send a message that CDPAP Personal Assistants (PAs) are worth less than other home care workers.

  • We strongly oppose the elimination of designated representatives (DRs). DRs have been part of CDPA from its days as a New York City-governed pilot program. DRs assume the responsibilities of consumers who are unable to self-direct for reasons including age (one must be at least 18 years old), cognitive impairment, and linguistic barriers. DRs are unpaid and may not be the consumer’s PA, therefore any savings can  only be gained by denying services to an estimated forty-fifty percent of consumers currently receiving CDPA, as well as those who would be denied in the future, since personal care or other services do not exist in quantities to fill the need. If enacted, this would be a clear case of discrimination against consumers with specific disabilities that hinder their ability to self-direct.   Those who rely on CDPAP for skilled tasks could not be transferred to traditional personal care and would be forced into nursing homes at higher cost to the state.

  • We oppose daily and weekly limits on the number of hours a PA may work. New York already has one of the worst  home healthcare worker shortages in the nation. This is partially why CDPA has increased at such a rapid rate.  Consumers routinely struggle to staff some or, in some instances, all of the hours in their approved plans of care, particularly when providers limit overtime due to insufficient reimbursement rates from managed long-term care plans. Other workers in healthcare and other industries are not restricted in this manner outside of a “day of rest” provision applied to specific jobs. Enacting this would create an arbitrary rule that harms consumers. 

  • We oppose the mandated training of PAs. One of the main consumer responsibilities within CDPA is training. Taking that power away from the consumer defeats the letter and spirit of the law as it was created.   Many PAs do “skilled” tasks for which FIs do not have staff legally allowed to provide the training.  For others, delays in obtaining training will imperil the health and safety of those who use the program. All indications are that consumers in CDPA have better health outcomes than those in other programs, calling into question what problem this proposal is seeking to solve.

  • We oppose the repeal of the contracting process  The RFO process for FIs should not be abandoned. This budget would replace a carefully negotiated process that is resolved with an authorization process that creates new uncertainties for FIs, consumers, and personal assistants and would only further delay that transparency and accountability the Department seeks. The state should move forward with this process.       

  • We oppose the ban on combining LHCSAs and fiscal intermediary (FI) services under shared ownership. Since the inception of CDPA, LHCSAs that are also FIs have been a critical part of the program. For many Medicaid recipients, there is a desire, or need, to combine CDPA and agency-based services to ensure adequate staffing. Agencies that provide both, with proper firewalls in place, allow them to do so in an efficient manner. Further, many counties’ fee-for-service system, including New York City’s, is entirely reliant on agencies that exist under both programs, meaning New York City and many other counties could face an inability to offer CDPA if this were to pass.        

  • The changes would cause massive closure of FIs, destabilize the long-term care system, and disrupt care.   FIs that specialize in serving specific populations such as those with developmental disabilities or Limited English Proficiency (LEP) would close.  FI programs run by Independent Living Centers that bring cultural and disability competence and strong ties to their local disability communities could close.  Existing procedures for FIs that close are woefully inadequate to prevent disruption in care. 

     CDPA is a popular and proven program, made all the more necessary because of the dire workforce shortage.   While complaints of fraud have repeatedly been levied, the Office of the Medicaid Inspector General reported the program had 99% reporting accuracy (only $46,000 recouped on $37 million in audits) in 2022, with 0.0002% of personal assistants being referred to the Attorney General’s Medicaid Fraud Control Unit. We join in urging the legislature to reject these and all cuts to CDPA in the final budget to preserve access for New Yorkers across the state to vital services that empower them to live at home and be active participants in their communities.  

 

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