Office for People with Developmental Disabilities (OPWDD)
March 2013
PROPOSED 6% CUT TO OPWDD
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We thank our legislators for their support for full restoration of the 6% cut to OPWDD. We urge them not to compromise on this position until the budget is final.
The Governor is proposing an enormous cut to OPWDD. His $120 million cut in state funding actually results in a $240 million loss. Most OPWDD services are funded through Medicaid so that every state dollar is matched by a federal dollar. Thus, any state cut is doubled by the loss of matching federal dollars. Regardless of the reasons for this cut, its victims are people with developmental disabilities who could lose many services that are essential to their safety and well-being.
This punishing cut will destroy our services. Over the last three years, providers have taken over $167 million in cuts, and now there are no more “efficiencies” to take. Inevitably, staff will be laid off, leaving our vulnerable population unprotected and neglected and at risk of every conceivable calamity. Entire programs will close, and some agencies will shut down. This extensive cut will destabilize the OPWDD system just as it transitions into managed care, guaranteeing failure.
RESIDENTIAL SERVICES
- The Legislature must provide funding for the development of 24-hour residential services for 200 individuals, at a cost this year of $8 million (state share).
Yet again, the Executive Budget turns its back on families needing 24-hour residential services. For the past four years, there has been a virtual stranglehold on development of such services. And this year, although the budget includes $30 million for less costly services, there is absolutely nothing for individuals who require round-the-clock residential services.
In Manhattan alone, 52 people are in urgent need of residential services—up 21% from last year! But it is a crap shoot whether a particular person will be a match with a particular vacancy. People with the severest disabilities may never find a match. Families are living in fear, knowing that family support services, helpful as they are, will not sustain them in a crisis. New York must accept its responsibility and dedicate funds for new 24-hour residential services.
MANAGED CARE ENTITIES
- The Legislature must insist that all managed care entities in the People First Medicaid Waiver be held to OPWDD’s original standards.
- The budget language should define “habilitation” and recognize habilitative services as core developmental disabilities services.
In planning for its sweeping transformation into a managed care system, OPWDD explicitly stipulated that the managed care entities in the People First Waiver must be experienced providers of developmental disabilities services. Further, these entities would have to maintain an adequate and diverse provider network, adhere to established time frames, measure personal outcomes, utilize person-centered planning, and abide by other requirements. The Executive budget nullifies this commitment by inviting non-profit insurance companies that do none of these things to be managed care entities in the OPWDD waiver.
Commercial health insurance companies operate on a medical model—they pay for services to cure patients. But while people with developmental disabilities can certainly learn new skills, they cannot be cured. They need a “habilitative” model, which offers coordinated long-term and health care services that address all aspects of their lives—home, relationships, personal growth, work, and meaningful community activities. A medical model is unworkable for their overall support needs.
DEPARTMENT OF HEALTH (DOH) JURISDICTION
- OPWDD must maintain authority over developmental disabilities policies and programs.
An Executive proposal would shift authority for developmental disabilities services away from OPWDD to DOH. DOH would have oversight of all Medicaid administrative functions, including managed care contracts and rate setting. OPWDD’s People First Medicaid Waiver would be administered by DOH—with “input” from OPWDD.
The unique complex needs of people with developmental disabilities will be ignored among the competing interests within DOH—hospitals, nursing homes, and a vast health care system.
DOH lacks the expertise to develop sound public policy regarding developmental disabilities services. DOH does not understand the specialized needs of people with developmental disabilities, particularly those with truly high needs. Moreover, DOH utilizes a medical model of care and is unfamiliar with essential habilitative services (see Managed Care Entities, above). The medical model encourages skimping on care for those who can’t be cured. Habilitative services, however, aim to include people in their communities to the fullest extent possible, in full accord with the Olmstead law.
ARTICLE 28 CLINICS
- DOH must terminate its retroactive recoupment of capital rate payments for Article 28 clinics and instead institute a multi-year glide path for any prospective rate reductions.
In a long-overdue move for Article 28 health care clinics, DOH will reinvest $37.5 million in a retroactive increase to the operational portion of the rate. With rates that have been frozen for nearly two decades, many Article 28 clinics have been operating under tremendous losses. Fortunately, these losses were offset, to some extent, by the capital portion of the rate.
But what DOH is giving with one hand, it is more than obliterating with the other. Without the required 30-day notice, DOH has rebased the capital component of the rate based on 2007 cost reports and will utilize the rebased rates going forward. DOH is also retroactively recouping any difference between the current rate and the rebased rate back to 2009! Many clinics are already experiencing significantly lower payments as the increase to the operational portion of the rate is dwarfed by an enormous giveback and the new capital rate reduction. We question the legal basis for a retroactive recoupment when services were delivered and paid for within the rate issued by DOH at the time.
This cut will be the breaking point, compelling many Article 28 clinics to cut services drastically or even to shut their doors. Patients who rely on the specialized developmental disabilities expertise of many Article 28 clinics will lose access to virtually all their health care services. Many will end up in much more costly emergency rooms or in-patient service settings.