1. Announcements
Manhattan Legislative Breakfast
Friday, March 11, 2011, 8:00-10:00 am
Barnes & Noble Union Square, 33 East 17th Street
Please try to attend – Show that we care!
See Below for Committee Meeting Schedule
2. Report on December Statewide Family Support Committee Meeting
Max Chmura is still the Acting Commissioner of OPWDD. In terms of the NYS budget, he reported that he expects more cuts in budget than previously and that the Division of the Budget understands the importance of safety net services including family support, adult day services, and other services to sustain families in need of residential placement.
Two powerpoint presentations were shown:
One, by Nancy Thaler, Executive Director of the National Association of State Directors of DD Services, discussed a national view: that DD need is outpacing supply of direct support professionals, which is declining as the adult population ages, outpacing females 25-44 years old, the group that does direct support. Additionally, people with DD are aging. Nationally, we can’t afford to pay for 24-hour residential services for everyone, and we could not staff such services even if we could afford to pay for them. We have residential waiting lists, and caregivers are aging. More people are living with their families. The challenge is to find ways, such as person-centered planning, and personal control of budget, to support families caring for their child at home.
The second presentation was an OPWDD powerpoint on Planning for Our Future. In light of past and anticipated budget cuts, with very little funding available for new residential development, these are goals and issues:
• Maintain support for the 126,000 people being served as well as the new people coming in (1200-1500/yr). Services may look different.
• Cross-systems access to services
• Services should be person-centered and portable
• Stable funding
• Simplified and streamlined administration, regulations, and accountability
• Innovation –fostered by environment, especially since services can’t remain the same
OPWDD itself has had deep cuts—can’t continue in same roles. For example, the state will no longer conduct training sessions but will assure training is provided. Over the next 15 years, OPWDD will:
• Take advantage of broader Federal Health Care Reform
• Maximize service opportunities within available resources—fairly and equitably, reflecting all levels of need
• Address increasing needs–of aging people and new people including those with autism and high medical and behavioral needs
• End reliance on Developmental Centers—close by 2014. Convert intensive treatment units to time-limited. Expand community capacity for emergency or crisis placement
• Enhance fairness and portability and choice
• Simplify the reimbursement structure
• Reduce administrative burden
• Reward excellence
• Focus on outcomes as well as compliance
Also, the committee discussed what is needed in family support services in this climate. Some ideas from members: Need well-trained staff; offer housing and benefits to staff; get services in unserved areas of state; train staff to work with people with complex medical/behavioral needs and pay them more; crisis intervention; behavior management; overnight respite; short-term highly structured intensive treatment in the community for when person has to be removed for months or years to avoid institutional placement. More ideas are welcome. Please share your ideas with Margaret.
3. Medicaid Redesign Team
Max Chmura held a phone conference to discuss the charge of the Medicaid Redesign Team (MRT), which is to find savings in NYS Medicaid. With a budget deficit of $10 billion in 2011-2012 and more in the following years, there is no way to avoid cuts. The purpose of the MRT is to reduce costs and increase quality and efficiency. MRT will look at 1) efficiencies, 2) short-term restructuring 3) long-term restructuring. Their recommendations for short-term issues are due on March 1, one month after the Governor releases his budget. The MRT will continue until the end of Fiscal Year 11-12 for longer-term issues. There will be public forums around the state to solicit suggestions for reductions, and there is a website where people can submit their suggestions: http://governor.ny.gov/medicaidredesign. The website points out that 20% of Medicaid enrollees drive 80% of Medicaid spending. The 20% includes people with disabilities, those with HIV, mental health, substance abuse, and long-term care needs. Waiver services for people with DD are identified as very high cost and growing rapidly.
The MRT includes NYS Medicaid Director Jason Helgerson: he is executive director of MRT; the NYS budget director is non-voting member. The team includes: Jim Introne, a past commissioner of OMRDD; Max Chmura; Ed Matthews, Executive Director of UCP/NYC; Lara Kassel (Coordinator of Medicaid Matters); and Dr. Jeffrey Sachs of JFK Institute for Worker Education at CUNY
Jason Helgerson was Wisconsin’s Medicaid Director and oversaw the process to find Medicaid savings and efficiencies in Wisconsin, where he needed to save $625M—a 10% cut to total Medicaid cost. The NYS effort is modeled on the Wisconsin approach, which solicited ideas from all over the state. The Wisconsin reforms made the cuts but also increased coverage and implemented important reform.
A working group has been established to help Max and Ed with ideas.
4. Presentation: Al Kaplan on What Families Need to Know About the Budget
Formerly Deputy Director of the Division of the Budget, Deputy Commissioner of OMRDD, OMRDD budget director, and member of the State Senate Finance Committee, Al Kaplan explained how the budget is put together, and what the budget process entails. In the 1920’s, the Governor pushed for a strong budget process in New York State, which continues today. Under this process, the Governor is responsible for developing and preparing a comprehensive, balanced budget proposal, which the Legislature modifies and enacts into law. Go to www.budget.state.ny.us for complete details on everything budget related. Under SEC regulations, the governor’s office has a responsibility for full disclosure because NYS is a borrower and bond distributor.
The NYS budget is based on of hundreds of thousands of decisions. With all the bills included, it can be as much as 20,000 pages of material. This year’s total budget is about $137 billion. The budget is made up of the general fund ($54 billion comprised of tax dollars) as well as federal and other funds. State agencies start presenting their assumptions and guesses for their annual budget almost a year in advance of the start of the budget year (April 1).
After the budget is passed, DOB puts out an enacted budget report. Quarterly reports come out to show how the budget is performing so far (available on the website), and to start predicting for the following year. The quarterly report that comes out in July after the first quarter is very important: it begins to form the basis of the next year’s budget. In September DOB figures out how to fill the gap. Final decisions are made by January 1, and the Executive budget is released in early February. The base budget is 90% of the entire budget. The base is a mirror of this year’s budget, showing this year’s programs annualized at next year’s costs, including inflation, new expenses, etc.
The revenue side is the other side of the budget. The difference between revenue and spending is the gap (deficit). Since the NYS Constitution requires that the Governor submit a balanced budget, the budget must close the gap between expenses and revenue. The deficit is calculated only on the general fund. The deficit for 2011-2012 is $10 billion, nearly 20% of the general fund. To fill the gap, DOB looks for ways to cut expenditures as well as ways to expand revenue, which can include taxes, fees, and similar charges. The deficit can be reduced by bringing in federal dollars, such as Medicaid dollars.
Generally, the Governor and DOB try to avoid cuts to school aid and Medicaid. This year, however, Medicaid is a prime target. Once the deficit-reduction measures are taken, the Governor calls for an across the board cut of a given percentage for all state agencies. The DOB process entails first figuring out how much will be cut from school aid and Medicaid and then dividing the balance of the deficit among the agencies. DOB hears from advocates and works with the Governor’s staff to create a plan that the Governor can accept and present to the public.
Al pointed out that the critical role of the advocates, which is to point out unintended negative effects of the budget proposals since DOB and the legislators may not be aware of the impact of the cuts.
Al also presented several ideas of ways to minimize the impact of the cuts on OPWDD services by short- and long-term strategies to enhance revenue and to preserve the federal Medicaid match. (Over 95% of OPWDD services are funded through Medicaid, involving a 50/50 state/federal contribution. If $1 in state funds is cut, we also lose the $1 that the federal match would have provided; therefore, for every $1 cut in state funding, we lose $2.) One idea is to combine certain back-office functions across state agencies; another is to utilize the purchasing power of the employees of all state agencies to negotiate better insurance and purchasing rates. Other strategies outlined by Al are too technical to be described here.
MEETINGS:
Childrens Committee
Friday, January 28, 2011, 9:30 am- 12:30 pm
AHRC Pre-School, 15 West 65th Street
Information: Christina Muccioli (212) 780-2532
Legislative Committee
Friday, February 4, 2011, 9:00 am
AHRC, 83 Maiden Lane, 11th floor
Information: Judy DeIasi (212) 780-2667
Family Support Services Committee
Tuesday, February 8, 2011, 10:00 am – noon
UCP NYC, 120 East 23rd Street, 5th floor
Information: Amy Bittinger (212) 979-9700 x 708
Transition Committee
Wednesday, February 9, 2011, 9:30 am – noon
UCP of NYC, 122 East 23rd Street, 1st floor board room
Information: Kathy Kelly (212) 780-2724
DD Council
Thursday, February 10, 2011
InterAgency Council, 150 West 30th Street, 15th floor
Information: Margaret Puddington (212) 799-2042
Family Advocacy Day
Friday, February 11, 2011, 10:00 briefing followed by visits to your legislators
InterAgency Council, 150 West 30th Street, 15th floor
Information: Margaret Puddington (212) 799-2042