On Thursday evening, the Governor released amendments to her budget. These amendments are an annual occurrence and are meant to be technical fixes to address inevitable drafting errors in a series of bills that are cumulatively thousands of pages of text. This year, they were far from just technical fixes. Among other things, the Governor proposed 15 pages of new changes that would, in many cases, fundamentally change CDPAP (spoiler alert – it’s always for the worse).
The bill would eliminate Designated Representatives, or DRs. DRs have been a part of CDPAP since the program was created in 1980. The DR acts as the consumer when the consumer themselves are unable to self-direct their own care. This change will mean that no child will be able to use CDPAP. Many with developmental disabilities who use CDPAP to complement their OPWDD self-direction budgets use a DR. Those with Alzheimer’s disease or dementia rely on a DR. And thousands of others. This change would leave tens of thousands of people, if not over 100,000 people, suddenly ineligible for CDPAP, with no identifiable way for them to receive services in the current workforce crisis.
The bill will require state mandated training for PAs. A hallmark of CDPA has always been that the consumer – not an agency and not the state – is responsible for recruiting, hiring, training, supervising, and terminating their own staff. This has worked for over 40 years. Governor Hochul would prevent a PA from being able to work until they have completed a state-mandated training course, removing one of the core pillars of consumer responsibility that is a founding principle of the program.
The bill will set maximum daily and weekly limits on the hours PAs can work. Some FIs allow overtime. Some do not. Some consumers want PAs to work overtime. Some consumers need PAs to work overtime. Some consumers do not. Governor Hochul wants to tell consumers and PAs how many hours the PA can work each day and each week, taking more control away from the consumer. They do not say what those hour limits would be.
The bill will limit the number of FIs that a plan or a county can have in their network. The state’s position has always been clear – contracting is a process between two private third parties that they do not get involved in. The Governor wants to limit the number of FIs that a plan and county can now have in their network, limiting consumer choice along with it. The number of FIs that will be allowed is not identified.
The bill prevents an agency from offering home care and CDPAP. Sometimes, consumers want to be able to mix CDPAP and home care services, filling some hours with a personal care aide through “traditional” services and the rest through CDPA. This can happen for many reasons. They might have one person they want as their PA, but cannot or do not want to hire others and want an agency to send people. They might have a particular service they are not comfortable training a PA on. Their PA(s) might not be available on a particular day. In these instances, being able to use one agency for both “traditional” personal care and CDPAP can make life much easier. The Governor’s bill would prevent an agency offering CDPAP from being a LHCSA in Medicaid.
The bill prevents insurance companies from being FIs or LHCSAs. Ok, I said mostly bad. This is actually a good idea – and one that we had codified years back and the Cuomo administration repealed with the RFO. The insurance companies are the payors. They should not also be allowed to be the payee. Imagine going to a job and getting to set your own wage! Worse, the insurance control the networks, and often (though they aren’t supposed to) direct consumers to particular FIs or LHCSAs. This is a clear conflict of interest and eliminating the practice is a good idea.
Clearly – the next few months are going to be a long road, and we are going to need you – and your networks. If you are not a member of CDANY, please consider joining for just $22.50 a year. The more members we have – the stronger we are. Plus, we’ll send you a cool CDANY sticker!! If you’re already an individual member, thank you.
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Take action today to tell your legislators and Governor Hochul that PAs aren’t second class home care workers and they cannot undo all the progress we’ve made on wages and cut wages and benefits to levels we haven’t seen in over half a decade.
Then, be ready. You’re going to get a lot of emails over the next 45 days or so. We will have more campaigns asking you to email your legislators and the Governor on these other critical issues. We’ll be announcing events – in Albany and around the state. We’ll be giving you updates on how things are going here in Albany. We will give you all the tools to be the best advocate you can be – at whatever level you can.
Because this is YOUR program. It is your life. Fight for it.