DOH Reconciles Minimum Wage Funding for Assisted Living
The Department of Health (DOH) is moving forward with processing payment adjustments that will reconcile minimum wage add-ons that Assisted Living Programs (ALPs) received in 2017, 2018, and 2019 to actual need for minimum wage funding. A Dear Administrator Letter (DAL) distributed on March 9th and available here indicates that payment adjustments related to the reconciliation will be reflected in Medicaid payment cycle 2273 (check date of March 15th, check release date of March 31st). The DAL links to the reconciliation calculations (available here), which will result in recoupment of overpayments or additional payments for shortfalls.
Members will recall that the reconciliation process has not gone smoothly, with the latest reconciliation survey replacing two previous ones. We recommend that members review the calculations carefully and contact DOH at ALP-Rates@health.ny.gov with any questions. If DOH determines that a program received more funding than warranted, the program's Medicaid payment will be reduced by 15 percent until the liability is satisfied. Programs facing financial difficulties should contact DOH to discuss a reduced recoupment rate.
DOH calculates estimated minimum wage add-ons to Medicaid rates based on survey data submitted by ALPs prior to each rate year starting in 2017 and reconciles to actual need based on surveys conducted afterward. This marks the first reconciliation of ALP minimum wage and includes years in which the minimum wage add-on was calculated on a regional basis. The regional approach distributed minimum wage funding to all programs, including those that reported no estimated need and likely had no actual need. The reconciliation is designed to recoup any overpayment of minimum wage funding and provide additional funding where shortfalls may exist.
The State defines “actual need” as dollars required to increase hourly wages to the minimum wage, but only for those workers whose wages need to be increased at the start of each year to meet the new minimum. It also includes increases of wage-sensitive benefits driven by the minimum wage.
While this action will reconcile minimum wage funding for 2017 through 2019, members should be aware that DOH will now turn its attention to reconciling 2020 funding and updating the minimum wage add-ons that are currently in the rate. Please let us know if you identify discrepancies in the calculations shown for your program or if you have questions.
Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828 or Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841