Legislative Bulletin: Final Stretch of Budget Advocacy
One-house budget bills are out, and both chambers of the legislature are working with the executive to establish the final SFY 2019-2020 budget. We are preparing for what could be the final week of budget advocacy and we need your help!
All Hands on Deck for Budget Advocacy!
Legislative leaders had their eyes on the clock this week as final budget negotiations continued ahead of the April 1st deadline. In the pursuit of an on-time budget, the General Budget Conference Committee (the “Mothership”) announced the “table targets” on Thursday. The table targets indicate the spending amount that each of the joint legislative budget subcommittees can use to restore cuts, modify proposals, or fund new initiatives. $30 million has been allocated to the Health subcommittee, with $50 million for Human Services and $10 million for Environment/Housing/Agriculture. Lawmakers will not be able to cover each of their stated priorities with these amounts, which are smaller than we have seen in past years.
Over the next few days, difficult decisions will be made to finalize what is in and what is out of the FY 2019-2020 budget. LeadingAge New York expects there to be budget discussions over the weekend and we are likely to see final budget bills in print as early as Tuesday or Wednesday of next week.
During this final stretch, other advocates will be flooding lawmaker offices with phone calls and social media posts promoting their initiatives. If we do not step up our efforts, particularly on Facebook and Twitter, our message will be drowned out.
LeadingAge New York needs your advocacy on several proposals pertaining to adult care facilities (ACFs), assisted living, nursing homes, home and community-based services (HCBS), and senior housing that remain up in the air. Your calls and social media messages are particularly imperative if your legislators serve on the Mothership or the budget subcommittees. Our service line-specific talking points, sample tweets and Facebook posts, and one-house budget summary will be useful in your efforts.
You can easily find your legislators’ social media information by using our Find My Legislators tool.
Adult Care Facilities (ACFs)/Assisted Living
SSI Increase
- Tell your Assembly Member: Please include the Senate’s proposal to increase the SSI rate for ACFs by $20 per day per resident over five years in the final budget agreement! #NYbudget #SupportOurSeniors
- Tell your Senator: Thank you for including an SSI increase for ACFs in your one-house budget proposal! Please continue this strong support during final budget negotiations. #nybudget #SupportOurSeniors
Capital Funding
- Tell your Assembly Member: Please include the Senate’s health care capital transformation grant proposal, which would allow a minimum of $20M to be awarded to the development of new assisted living program beds, in the final budget agreement! #NYbudget #SupportOurSeniors
- Tell your Senator: Thank you for supporting ALPs and ensuring that the Senate’s health care capital transformation grant proposal, which would allow a minimum of $20M to be awarded to the development of new assisted living program beds, be included in the final budget! #NYbudget #SupportOurSeniors
Assisted Living Program Expansion
- Tell your Assembly Member: Please include the Senate’s proposal to expedite the development of an Assisted Living Program application process based on need in the final budget! #NYbudget #SupportOurSeniors
- Tell your Senator: Thank you for ensuring that the expediting of the development of an ALP need-based application process is in the final budget! #NYbudget #SupportOurSeniors
Case Mix
- Tell your legislators: Thank you for opposing the initial cuts to case mix. Please continue to ensure that there is no retroactive action on case-mix adjustments. Medicaid already pays less than the actual cost of providing care in a skilled nursing facility. This action would be detrimental to nursing homes’ survival and the quality of care provided to New York’s seniors. #SupportOurSeniors #NYBudget
CNA Workforce Training
- Tell your legislators to support a LeadingAge NY proposal to fully utilize federal Civil Money Penalty Funds, that are currently going unused, to support CNA training. There is currently $8 million in federal funds in the Civil Money Penalties account, but appropriation authority for only $1 million. For this reason, this proposal does not require any additional revenue or affect the State’s “balance sheet.” Please share our proposal with your legislators and ask them to include it in the final budget.
Home and Community-Based Services (HCBS)
Hospice Medicaid Eligibility
- Tell your Assembly Member: Please support the Senate’s proposal to expedite Medicaid eligibility determinations for those with an immediate need for hospice. #SupportOurSeniors #NYBudget
- Tell you Senator: Thank you for including language that would expedite Medicaid eligibility determinations for those with an immediate need for hospice. #SupportOurSeniors #NYBudget
Fiscal Intermediaries
- Tell your Assembly Member: Thank you for opposing the proposal to consolidate Fiscal Intermediaries that support the Consumer Directed Personal Assistant Program (CDPAP)! #SupportOurSeniors #NYBudget
- Tell your Senator: Thank you for opposing the proposal to consolidate Fiscal Intermediaries that support the Consumer Directed Personal Assistant Program (CDPAP)! #SupportOurSeniors #NYBudget
Affordable Independent Senior Housing Assistance Program
- Tell your Assembly representative: Please include the $2M ($10M over 5 years) investment for an Affordable Independent Senior Housing Assistance Program in the final budget agreement! The program offers proven savings and will pay for itself! #NYbudget #SupportOurSeniors
- Tell your Senator: Please include the $2M ($10M over 5 years) investment for an Affordable Independent Senior Housing Assistance Program in the final budget agreement! The program offers proven savings and will pay for itself! #NYbudget #SupportOurSeniors
We also ask that you encourage your colleagues, staff, families, consumers and board members to share the messages that are most impacting your community. The more people bringing these issues to the attention of the legislature, the better. And don’t forgot the importance of sharing these messages on social media - Facebook and Twitter offer an opportunity to vastly expand our reach.
Case-Mix Cut Still a Threat
Last month, the 30-day amendments proposed cutting Medicaid by $550 million in the FY 2019-2020 state budget. In light of President Trump’s federal budget proposal, the Governor’s administration has since signaled reversing the support of those cuts, recognizing that cuts from both the federal and state government would be unsustainable for New York’s healthcare providers. While this is great news for all Medicaid providers, nursing homes are still at risk to lose funding.
From the very beginning of this year’s budget season, the proposal to alter how nursing home rates are adjusted for case-mix has been the biggest threat to New York’s long term care system. While we are pleased that both the Assembly and Senate have adopted our budget language, which would ensure that any action taken on case mix be done prospectively, we are hearing that the executive is still pushing for a retroactive cut to case-mix reimbursement. DOH estimates that the initial proposal would have a provider impact of $245.6 million. While provider-specific impacts would depend on the implementation details, any retroactive action on case mix would likely impact every home.
We need you to keep the pressure on and remind your legislators that Medicaid already pays less than the actual cost of providing care. This action would be detrimental to nursing homes and the quality of care provided to New York’s seniors.
If you enter some basic information in our Find My Legislator Tool, you will be given direct links to lawmakers’ social media pages and contact info. To reach Governor Andrew Cuomo, it is best to use letters and social media.
Tell the Executive and your legislators: Please ensure that there is no retroactive action on case-mix adjustments. Medicaid already pays less than the actual cost of providing care in a skilled nursing facility. This action would be detrimental to nursing homes’ survival and the quality of care provided to New York’s seniors. #SupportOurSeniors #NYBudget
Have a Capital Project in the Works? Prevailing Wage Will Increase Costs
Both house’s budget bills include the language from bill, A.1261(Bronson)/S.1947(Ramos) , which would impose public works “prevailing wage” requirements on most types of private sector projects receiving any level of financial support from state or local entities. LeadingAge New York opposes this legislation, as prevailing wage requirements could increase labor costs by 25 percent or more, thereby increasing overall construction project costs by 15-20 percent for many projects. The legislation would also have a direct negative impact on affordable senior housing by discouraging the construction of tens of thousands of affordable homes that have been planned and funded for the coming years. LeadingAge New York’s official memo of opposition can be found here.
If you are planning a capital project using state or local financial programs, we strongly encourage you to reach out to your legislators to inform them of the potential impact!
- Tell your Legislators: Non-profit providers cannot afford prevailing wage requirements that will increase the costs of construction. [Share the impact this proposal would have on your development plans]. Renovations and capital projects are vital in ensuring quality care and homes for New York’s seniors.
E-Prescribing Legislation Passes in both Assembly and Senate!
LeadingAge New York’s e-prescribing bill (A.1034-A/S.4183) which exempts nursing homes from the electronic prescription mandate has passed in both the Senate and the Assembly!. The bill extends the current exemption to October 31, 2021. It is understood that nursing homes need a more permanent solution to the e-prescribing mandate. LeadingAge New York will continue to pursue those solutions with the Department of Health and the legislature.
Trump Budget Proposes Cuts to Aging Services
Although it is only the first step in a process that Congress will control, President Trump’s budget proposes to cut Medicaid and Medicare spending by more than $2 trillion over 10 years. The proposal once again calls for Medicaid funding to states to be restructured using a block grant approach or per-person caps and seeks to do away with provider taxes. Cuts to Medicare would exceed $800 billion over 10 years, $100 billion of which would come from post-acute care services which would be required to shift to a site-neutral payment system by 2025. Senior housing and non-medical community aging services would also face reductions. A LeadingAge National article listing proposed reductions to a number of other programs that serve seniors is available here.
The President’s FY 2020 spending request also included a $9.6 billion, or 16.4%, cut to Housing and Urban Development (HUD) compared to the FY19 HUD funding. According to HUD, 33% of public housing apartments are led by older adults.
The proposed budget is only the first step in the process of crafting the budget for the fiscal year that will begin on October 1, 2019. It is now up to Congress to determine spending levels for federal programs for fiscal year 2020. Although these proposals are unlikely to pass as they are currently written, they do illustrate the importance of building relationships with your congressional representatives.
National Leadership Summit and Lobby Day Recap
This week, LeadingAge New York staff and membership attended the LeadingAge Leadership Summit in Washington, DC. The summit offered workshops, education sessions and 10 Hill visits with the New York congressional delegation. Although Congress was not in session, attendees had substantive meetings with top congressional staff on issues such as Medicaid funding, regulatory reform, and senior housing. There also was positive support for our CNA training lockout legislation, which addresses the regulation that further enhances the mounting workforce crisis.
If you were unable to join us in Washington this week but would like to work with Congress on the issues affecting your organization, there is luckily plenty of time that Congress members are at home in the district. The House Session Calendar and the Senate Session Calendar are great tools for planning an in-district meeting with lawmakers. We encourage you to schedule meetings with your congress members and bring the below federal issue briefs to help make your representatives aware of our national policy priorities.
Ami Schnauber, aschnauber@leadingageny.org, 518-867-8854
Sarah Daly, sdaly@leadingageny.org, 518-867-8845