Legislative Bulletin: Call State Lawmakers TODAY to Raise Top Budget Concerns

March 18, 2022

LeadingAge NY Provides Comprehensive Overview of One-House Budgets

As anticipated, over the weekend both the Assembly and the Senate advanced their one-house budget proposals and continuing resolutions for expedited passage. The Assembly Budget Resolution (HR 644) and the Senate Budget Resolution (SR 2081) enable each house to pass their budget bills without requiring the legislation to “age” for three days. Both houses passed their respective budget resolutions on Monday.

While LeadingAge NY was pleased to see many of our priorities included in the Executive Budget Proposal, the Legislature’s budget positions represent a step backward in several areas. Although both houses made a substantial investment in “Fair Pay for Home Care,” neither house provided a meaningful across-the-board Medicaid rate increase for other long-term care providers - despite those providers having endured 2 years of a pandemic and going on 14 years without a cost-of-living adjustment. We are also disappointed that no pandemic relief funding has been provided to adult care facilities. Unfortunately, both houses also rejected the Governor’s proposal to authorize the use of medication aides in the nursing home. Highlights of both the Senate and the Assembly one-house budgets as they relate to senior housing and long-term/post-acute care were sent directly to LeadingAge members on Thursday in our One-House Budget Update.

As the Legislature and the Governor begin to finalize a State Fiscal Year 2022-23 Budget, due April 1, 2022, it is critical that we keep the pressure on lawmakers to ensure that our budget requests are being heard and taken into consideration. While we are disappointed by much of the one-house proposals, many of our priorities remain in the mix via the Executive’s proposals and the surplus of State revenues. We will need to redouble our advocacy efforts over these next 13 days to ensure that our important budget concerns are heard by our elected officials and legislative leaders.

Read on to learn how you can engage in advocacy during these final two weeks of budget negotiations!

ACTION ALERT: Call State Lawmakers TODAY to Raise Top Budget Concerns

As the State moves toward a final budget agreement by the end of the month, please join LeadingAge NY and non-profit providers across the state in urging lawmakers to provide more adequate reimbursement to ALL long-term care providers!

LeadingAge NY urges all of our members to CALL YOUR STATE SENATOR, ASSEMBLY MEMBER AND THE GOVERNOR TODAY! Please note, even if you already reached out to your legislators earlier in this budget process, it is critical that you reach out again in response to the Senate and Assembly one-houses.

Below, members will find key budget talking points for different service lines. Please feel free to use any and all talking points that resonate with you and your organization. Your legislators’ phone numbers can easily be found by entering your information here. Additionally, please take a look at the General Budget Conference Committee and Health Budget Subcommittee membership list here to see if your lawmakers sit on these key committees. If they don’t, but you have connections to other legislators listed, please reach out to them in addition to your representatives. The members of these committees are particularly influential at this stage of the budget process. After you’ve made your phone calls, please take a moment to send a quick email to Sarah Daly at sdaly@leadingageny.org to let us know that you took action.

We have a small window of time to weigh in on the budget before a final agreement is made. Thank you in advance for your participation in advocacy at this critical moment!

Nursing Home Talking Points for Final Two Weeks of Budget:

I am extremely disappointed to see that neither the Assembly nor the Senate One-House Budget adequately address the critical needs of an incredibly important piece of the long-term care continuum – Nursing Homes.
Unfortunately, neither one-house budget provides a meaningful Medicaid rate increase to long-term care providers.
The State must provide equitable levels of workforce investment across all long-term care settings. We need state support to recruit and retain sufficient staff and offer competitive wages.
The 1% Medicaid rate increase provided in the Executive and one-house budget does not do enough to help struggling nursing home and long-term care providers like mine who have not received a cost-of-living adjustment in 14 years, have withstood two years of operating in a pandemic with inflated costs and mandates, and are now facing a 7.5% general inflation rate. If we had gotten a standard COLA over the last 14 years, rates today would be 31% higher than where they are today.
While the Legislature is still not offering to provide nursing homes with an adequate rate of reimbursement for our services, nor adequate investment in our workforce, we will very soon be expected to comply with the recently enacted 3.5 nursing staff minimum hours requirement. While this was a relatively attainable goal for us prior to the pandemic, trying to reach this requirement today as the national guard is still deployed in nursing homes across the state is unrealistic and only requires us to ask much more of the depleted and tired workforce we have left.
We need time and resources before we can be expected to comply with this lofty nurse staffing requirement. The data and numbers are out there – the state would need well over 10,000 newly trained and licensed nurses and aides in order to reach this mandate.
Additionally, I was very disappointed to see that both one-house budgets failed to include the Governor’s proposal to authorize the use of medication aides in the nursing home.
I urge you to do everything you can to support this inclusion of the Medication Aide Proposal in the final budget.
This proposal would authorize specially trained certified nurse aides (CNAs) to work as medication aides in nursing homes, administering routine medications to residents under the supervision of a registered nurse.
Approximately 25 states already authorize medication aides to perform these tasks in nursing homes, and NY’s Office for People with Developmental Disabilities also already allows unlicensed direct care staff to administer medications.
Right now, the National Guard is still deployed in many nursing homes across the state, helping to alleviate our lack of available staff.
Medication aides would help provide immediate relief to our workforce challenges. We need flexibility to be able to use our existing workforce more efficiently and effectively, for the benefit of our workers and our residents alike.

ACF/AL Talking Points for Final Two Weeks of Budget:

I am extremely disappointed to see that both the Assembly and the Senate One-House Budget proposals seem to have overlooked an incredibly important piece of the long-term care continuum – Adult Care Facilities and Assisted Living.
After over a decade of chronic underfunding, and after 2 years of a pandemic, it appears that the Legislature is once again under-funding our sector. Even during a budget cycle that offers more state resources than ever in recent history.
COVID-19 brought unprecedented challenges to ACF/AL providers, whose residents are among the most vulnerable to COVID. The extraordinary added costs related to COVID are causing considerable financial strain.
Meanwhile, workforce shortages are at a crisis level, threatening the viability of quality non-profit providers like mine, and also threatening seniors’ access to care.
The state budget cannot overlook the needs of ACF/AL providers who have been on the front lines since the very first day of the pandemic.
With that, I urge you to work with your colleagues to include a $75 million allocation in the 2022-23 Budget to help offset a portion of the costs and losses that ACFs and assisted living providers have incurred to date as they continue to address the pandemic.
Additionally, the Assisted Living Program (ALP) – the Medicaid funded assisted living - has not had a standard trend factor increase added to its rate since 2007, and in the middle of the pandemic, when other states increased provider Medicaid rates, the ALP was cut by 1.5 percent.
Provider Medicaid rates would be 31 percent higher today if trend factors had not been eliminated for the past 14 years.
The ALP is the only Medicaid assisted living option in New York, serving seniors who are at a nursing home level of care but do not need ongoing skilled services at approximately half of the nursing home Medicaid rate.
ALPs need a meaningful rate increase to ensure access to this nursing home alternative. Costs over the past 14 years have gone up significantly, and a 1% increase to the rate as proposed is simply not enough, and does not acknowledge the deep financial hole providers find themselves in.
Finally, the Executive budget includes a health care worker bonus that does not include employees of non-Medicaid settings, thereby excluding the vast majority of adult care facility and assisted living providers in the state.
Both the Senate and the Assembly include fair pay for home care proposals, that would bring home care worker wages above those of any other direct care worker in long term care and aging services.
Any effort to recognize and reward the work of direct care staff must include assisted living and adult care facilities. We have been on the front lines, caring for the most vulnerable populations, since the beginning of the pandemic. Rewarding only certain sectors will further destabilize the staffing crisis in this field.

Senior Housing Talking Points for Final Two Weeks of Budget:

I am calling you today to thank you and your legislative colleagues for the inclusion of $300M in capital funding for the development and preservation of affordable independent senior housing in the Executive and One-House budget proposals. This funding will help improve and expand housing options for New York’s growing population of low-income seniors.
However, we are disappointed that the Legislature has once again failed to complement its capital investment with a modest $5M investment of operational dollars that would support resident assistance in affordable senior housing. Resident assistants would work to identify low-income seniors’ unmet needs and connect them with existing resources in the community to help older New Yorkers remain healthy and independent for longer.
I hope that I can work with you in the future to help get this much needed state program off the ground.
I also encourage you to weigh in as the State plans to distribute more than $1B in state and federal capital funds to expand affordable broadband access. I ask that you do what you can to help ensure that low-income seniors and other vulnerable New Yorkers living in affordable housing are prioritized for that funding.

HCBS Talking Points for Final Two Weeks of Budget:

On the Home and Community-Based Services front, please note that both one-house budgets include Fair Pay for Home Care bill language. Last year, only the Senate budget included this proposal. LeadingAge New York has communicated its concerns about this initiative over the last several years. The proposal establishes the following:

A minimum wage mandate for home care aides of no less than 150% of minimum wage;
Sets regional minimum hourly base Medicaid reimbursement rates for workers subject to the mandate;
Sets regional base cash rates: $38.50 for wage parity regions; and, $38.18 in rest of the state.
Sets regional base benefit rates: $4.84 for wage parity regions; and $3.89 in the rest of the state.
Provides for regional base rates for CDPAS, but allows DOH to reduce those rates by no more than 12.9% if FI is given a PMPM increase to cover administration;
Assembly budget sets base rates for aides under NHTD/TBI;
Ensures managed care capitation is adjusted to ensure rate adequacy for the plans;
Establishes billing codes for overtime;
Senate bill creates fund with FMAP funding and proceeds from SNF bed decertifications;
Bills vary on effective date - October 2022 vs. January 2023.

LeadingAge New York supports increasing aide wages as well as a much-needed increase in Medicaid reimbursement for home care. However, we are extremely concerned the wage mandate for home care workers will put many agencies delivering non-Medicaid services in serious financial jeopardy.

Please take action TODAY and join us in voicing concerns about the Fair Pay for Home Care budget language.

Talking Points on Fair Pay for Home Care:

I am calling you today to voice concerns around the Fair Pay for Home Care Budget proposal which has been included in both legislative one-house budget proposals.
I and my organization support fair and adequate wages for home care aides.
I also support a much needed Medicaid rate reimbursement to cover the cost of wages, the delivery of care and the recruitment and retention of workers.
HOWEVER, as an agency serving patients who are not Medicaid beneficiaries, I fear that I will be left to cover this 150% wage mandate.
The Medicaid home care rate increase will not help agencies reimbursed by Medicare, Medicare Advantage and commercial payers.
The mandate for aides will also create wage compression issues with other agency staff.
A significant number of home care agencies have been operating at negative margins for years and COVID-19 has further exacerbated these challenging financial and operational conditions.
The State should cover the mandated worker compensation for workers caring for all categories of home care patients, not just Medicaid.
Simply put, this mandate will put many home care agencies out of business and threaten the stability of the home care sector.

Register for LeadingAge National Leadership Summit and Lobby Day Webinar!

LeadingAge National is hosting its Leadership Summit on March 28-30, in-person, in Washington D.C. The leadership summit convenes thought leaders from across the aging services sector for mission-critical conversations. The summit is among the most valuable networking events in the field, bringing together providers, businesses and policy experts over three days of keynotes, education sessions, VIP discussions, and meetings on Capitol Hill. More information on the summit itself is available here.

LeadingAge’s Lobby Days will be held in conjunction with the summit. Although many congressional offices are staying remote and virtual at this time, LeadingAge’s goal is to organize and schedule as many in-person meetings with congressional offices as possible as part of their 2022 Lobby Day activities. If you are interested in joining us to urge Congress to properly support and fund the nation’s aging services and the care needs of older adults, please click here to register for the Leadership Summit!

To ensure that members are prepared for congressional meetings, LeadingAge is also hosting a virtual “Know Before You Go” webinar with the Advocacy Guru, Stephanie Vance on Tuesday, March 22^nd from 2-3pm. During the webinar, Stephanie will go over LeadingAge National talking points, tips on how to have in-person meetings in this new environment and logistical support. If you are curious about National’s current advocacy priorities and messaging for lobby days, members can register for the “Know Before You Go” Webinar by clicking here.

If you have questions about engaging in federal advocacy initiatives, please feel free to contact Sarah Daly (sdaly@leadingageny.org) and we can help you get the answers you may be looking for.

Keep the Pressure on State Lawmakers - Send LTC Budget Letters TODAY!

As we find ourselves in the final weeks of state budget activity, it is critical that we keep the pressure on lawmakers and remind them of the budget requests that are most critical to the sustainability of non-profit long-term care and aging services providers. Using the below links, members can easily send digital advocacy letters to their State Senator, Assembly Member, and the Governor with just a few clicks!

Please use the links below to send messages to your legislators and the Governor TODAY! Even if you have already sent the below letters, please take a moment to do so again! Please also be sure to share these links with your colleagues and board members to expand our advocacy reach.

Invest in High Quality Nursing Home Care in This Year’s Budget

Invest in ACF/AL Providers and Workforce in This Year’s Budget

Provide Adequate Reimbursement and Investment to HCBS

Ensure Access to Safe and Affordable Senior Housing in this Year’s Budget

Oppose Competitive Procurement of Medicaid MLTC Plans

Support Adult Day Health Care in This Year’s Budget

Urge Congress to Fund Vital Aging Programs and Services

It is time for Congress to pass a long-term government funding bill that sustains and expands investments in home and community-based services, affordable housing for low-income older adults, and measures that address the aging services sector’s severe workforce challenges. Continuing resolutions do not allow for increases to key federal programs that sustain our aging services infrastructure.

CLICK HERE to send a message to your members of Congress TODAY, urging them to invest in aging services!

Right now, congressional leaders are negotiating federal investments in aging services programs for next year and we need your help! Too many older adults are struggling to access the essential services they need and funding levels must increase. Senators and Representatives must hear from constituents like you to stress the message that they can’t leave older adults behind.

LeadingAge & LeadingAge New York Coronavirus Resources

LeadingAge NY continues to closely follow all COVID-19 news and we are doing our best to keep members informed of updates, recommendations and guidelines from the Department of Health (DOH).

LeadingAge NY and LeadingAge National Member resources are linked below.

LeadingAge NY Coronavirus Resources

LeadingAge NY COVID-19 Weekly Update calls – Mondays at 11 a.m. Click here to join the call from your computer, android or apple device. Or you can join the call by dialing in: 877 853 5257 (Toll Free); Webinar ID: 852 964 255.

LeadingAge National Coronavirus Resources Page

COVID-19 Group in the MyLeadingAge Member Community

LeadingAge National Coronavirus Policy Updates – Mondays and Wednesdays at 3:30 p.m. Past call recordings are available here and you can register here for future calls.

Contact: Sarah Daly; 518.867.8845; sdaly@leadingageny.org