March Edition 2011 - New York Nonprofit Press

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10 New York Nonprofit Press www.nynp.biz March 2011 TRIPLE THREAT continued from previous page “We can say goodbye to what’s left of New York’s middle class if this devastating budget proposal is made law,” said Karen Scharff, Executive Director of Citizen Action of New York. “This budget represents the rich, real estate interests, and bankers giving themselves a tax cut by looting New York’s working families, school children, sick and elderly. Quality education and good jobs could fuel the economic engine New York needs to recover from this financial crisis. But, cutting billions from the state budget will leave our state’s economic engine dry. A budget that increases unemployment, raids school funding, and shuts down hospitals is not what New York needs. Our leaders in state government need to stop looking out for their big money corporate campaign contributors and start listening to the people who elected them.” “Instead of further cutting education, the Governor should continue the tax on high-earners, which would provide more than $5 billion in critical revenues,” said Leonie Haimson, Executive Director of Class Size Matters. “Wall Street bankers can afford to pay a little more to help our kids receive a better chance to learn, especially as their mistakes caused the economy to collapse in the first place.” The listing of concerns raised by advocates over the Governor’s budget proposals goes on and on. NYNP will continue to cover these issues over the coming days and weeks in our daily NYNP E- Newsletters. Mayor Michael Bloomberg laid out his preliminary budget for New York City’s FY2011- 12 on February 17th, a little more than two weeks after Governor Cuomo’s State budget presentation. The delay gave the Mayor a lot to talk about – namely $2.1 billion in funding which he claimed the City had just lost due to Cuomo’s budget cuts. The net result, said Bloomberg, was a loss of 6,000 teachers at the Board of Education and a lingering $600 million budget gap he still hoped the state would help him fill. Otherwise, there would be more City cuts coming. For human service providers, however, the Mayor’s budget already appears to be passing through approximately $370 million in cuts – much of it precipitated by reductions in State and Federal funding. Preliminary reactions focused on newly announced cuts to child care and senior centers. In both cases – the loss of 16,624 child care slots and the potential closure of 110 senior centers serving between 8,000 and 10,000 seniors – the cuts represent staggering reductions of one-third or more in the City’s commitment to services. The Mayor’s budget documents stated that the child care cuts were “due to federal funds not keeping pace with increased costs of care”. It is estimated that this represents a loss of $91 million in funding for child care. FIRE ALARM SERVICES • DESIGN • INSPECTIONS • 24 HOUR SERVICE “Ask about our 3 Year Warranty on New Systems and Unlimited Smoke Detector Replacement Warranty on Inspection Agreements” Serving Non Profit Agencies for 32 Years! • INSTALLATION ARRANGED • VIOLATION REMOVAL • “LETTERS OF DEFECT” APPEALED • PORTABLE FIRE EXTINGUISHERS SERVICED SERVING NY CITY & LONG ISLAND 888-274-7263 NYS Lic.# 12000032751 Mayor’s Budget Has $370 Million in New Service Cuts: 16,624 Child Care Seats, 110 Senior Centers info@briscoeprotective.com www.briscoeprotective.com “Mayor Bloomberg’s plans to cut subsidies for 16,624 children in the coming year is a devastating blow to the city’s children and working families, the biggest single cut to child care services since the 1970’s,” said six separate advocacy groups in a joint statement. “It represents a dramatic reversal of the Mayor’s promise to expand early learning opportunities for the city’s children and a retreat from his public statements in support of the city’s working families.” “Cutting 16,624 additional subsidies – on top of the 14,000 already lost since 2006– creates a serious hurdle in preparing all the city’s children for school,” the statement continued. “Tens of thousands of young children who need to be prepared for school will enter kindergarten behind, and stay behind. Thousands of families will be left scrambling for a safe place for their children while they are at work.” The statement was issued jointly by Brooklyn Kindergarten Society, Center for Children’s Initiatives, Children’s Defense Fund – NY, Citizens Committee for Children, Day Care Council of New York, Head Start Sponsoring Board Council, Federation of Protestant Welfare Agencies, and United Neighborhood Houses. The Mayor appeared to downplay what advocates saw as stunning cuts to critical human services. There was little or no mention of the impact of either cut during the budget presentation. “So far, we’ve managed without unduly harming essential services,” he said during his weekly radio broadcast following the announcement. Like Governor Cuomo, the Mayor took pride in the fact that his budget included no new taxes. When pressed on the cuts, Mayor Bloomberg took the position that these weren’t City programs at all. “Senior Centers are a federal program,” he said in response to a question during the budget briefing. Providers took issue with the Mayor’s efforts to divert responsibility for the budget cuts by claiming that these were non-mandated services and initiatives of the state or federal governments. Advocates noted that the City had a long history and commitment to funding these very services for seniors and low-income families. “The Preliminary Budget turns its back on the promises that we as a city have made to working families,” said Nancy Wackstein, Executive Director of United Neighborhood Houses. “This is the largest cut to early childhood services in decades. It dismantles much of the city’s support for working families and leaves behind a child care system that could force hard working parents out of their jobs and onto public assistance rolls in order to meet their children’s basic need for early education and care.” “This proposal contradicts the Mayor’s previous statements of support for working New Yorkers and demonstrates his lack of commitment to early learning opportunities for children,” said Annabel Palma, Chair of the City Council’s General Welfare Committee. “These cuts come in addition to the approximately 14,000 child care slots that have already been lost since 2006 and mark the single largest cut to child care services since the 1970s. If the Mayor’s proposal becomes a reality, thousands of working families Mayor Bloomberg’s preliminary budget would eliminate approximately one-third of child care subsidies for low-income families and close one-third of City-funded senior centers. will be left scrambling for child care and tens of thousands of children will enter school ill-prepared and behind their peers.” Advocates also cited the City’s long history of commitment to senior services. “Now, seniors are looking to see whether the Governor and the Mayor will maintain services and keep the centers on which they rely open,” said Bobby Sackman, Director of Public Policy for the Council of Senior Centers and Services (CSCS). “Nobody was elected to allow 110 senior centers to close.” “While we understand that the City is expected to lose a substantial amount of funding from the State because of the deep cuts proposed by Governor Cuomo, this reality is of little importance to those who rely on these critical services,” said Allison Sesso, Deputy Executive Director at the Human Services Council of New York. “The commitments made to our communities must be maintained. If the State fails to keep its obligations, New York City must find a way to fill those gaps and meet the need.” Providers are still working to clarify the impacts of other new cuts to human service programs, including the reported loss of $192 million for the Advantage rent subsidy program. While initial reaction focused on these new cuts, the Mayor’s preliminary budget for FY2011 continues to include a large number of previously announced Programs to Eliminate the Gap (PEGs), some of which were restored on a current year only basis by the City Council. “Services to seniors continue to get pummeled with $38 million in cuts to the Department for the Aging budget,” explained Bobbie Sackman. “Senior centers will lose meals, transportation, and core funding to keep the center open. About 8,000 frail homebound elders will lose 110 case workers - social workers who come to their homes to help them remain home safely. Elder abuse funds will be eliminated. We are concerned the Mayor might ask for more cuts. This is all in addition to the $27 million Title XX cut Governor Cuomo has proposed which would close 110 senior centers. With a $2 billion increase in tax revenue, there is a light at the end of the tunnel for the city, but it is still dark for older New Yorkers.” And, things could get even darker if the Mayor’s request to close a remaining $600 million budget gap with help from the State goes unanswered.
March 2011 New York Nonprofit Press www.nynp.biz 11 TRIPLE THREAT Medicaid Redesign Team Looks to Save $2.85 Billion Carve-In or Carve-Out? Could they do it? Was Governor Andrew Cuomo’s 27-member Medicaid Redesign Team (MRT) able to identify and vote on recommendations for $2.85 billion in savings for the upcoming FY2011-12 fiscal year? Their deadline was March 1st. By the time you read this, you’ll know the answer! You’ll also know how the MRT voted with respect to “Carve In/Carve Out” issue – perhaps the critical question for many human service provider agencies. Formed shortly after Governor Cuomo took office, the MRT’s members clearly have a Herculean task laid out before them. “All of us on the team are humbled by and fearful of what this means,” said Elizabeth Swain, CEO of the Community Health Care Association of New York State, following the group’s February 9th public meeting. “There is no happy ending when your job is to recommend cuts of the magnitude that we are talking about.” “It’s like trying to repair a plane while it’s flying… and on the way down,” said Ed Matthews, President of United Cerebral Palsy of NYC. “It is an extraordinary opportunity,” said Lara Kassel, Coordinator of Medicaid Matters New York. “At the same time, I recognize that it is a huge responsibility, particularly being the lone representative for consumer interests.” As we went to press, the MRT was evaluating an initial package of 49 “key proposals” from the Department of Health (DOH) for possible inclusion in their package of recommendations to the Governor. They were the first of some 274 separate suggestions – drawn from a list of over 2,000 submittedto the group. The Team was being asked to evaluate proposals based on four criteria -- Cost, Quality, Efficiency and Overall Impact – using a web-based assessment tool developed by DOH. The MRT was to discuss these 49 proposals as well as others at its next scheduled meeting on February 24th. An up-or-down vote on a full package of recommendations was scheduled for March 1st. Perhaps most important among the proposals up for consideration – at least for behavioral health providers -- was how the state should approach care coordination for New Yorkers with serious, ongoing psychiatric disabilities and substance use disorders. One of several major themes underlying the MRT’s work is the effort to “ensure that every Medicaid member is enrolled in Managed Care”. Advocacy and provider groups are concerned that individuals with a range of disabilities – mental illness, addictive disease, developmental disabilities, etc. – might be required to join generic Medicaid managed care plans currently serving the broader population. People with these disabilities are currently “carved out” of managed care and receive their services on a fee-for-service basis. Instead, the groups are proposing that the state serve these individuals through implementation of a regional behavioral care coordination model that relies on specialty managed behavioral health organizations (MBHOs). They point to a number of examples of similar service models which have allowed States to both improve quality of care while significantly reducing costs. For example, they argue that Pennsylvania’s Behavioral Health Choices Program generated $4 billion in savings over a 10 year period from 1997 to 2007. On February 14th, more than 40 statewide and regional advocacy groups gathered in Albany to urge state leaders to back the specialized, regional behavioral health organization approach. “Our proposal builds on proven, nationally recognized best practices that rely on the use of specialty managed care organizations called behavioral healthcare organizations (BHOs) to take over for the state the management of New York’s community recovery safety net,” said Harvey Rosenthal, Executive Director of the New York Association of Psychiatric Rehabilitation Services. “Our coalition strongly supports a specialty behavioral health ‘carve-out’ plan, which has demonstrated success in improving care and responsibly reducing costs, while capably integrating mental health and substance use services,” said Phillip A. Saperia, CEO of the Coalition of Behavior Health Agencies. “In various models around the country, specialty managed care behavioral health organizations have coordinated primary and behavioral health care and lowered the need for more costly inpatient, emergency, homeless, and criminal justice services.” At the same time, the groups strongly condemned efforts by health plans that currently manage health care for Medicaid beneficiaries to move into taking on the care of some of New York’s most vulnerable citizens. “New York must not turnover the management of mental health and substance use benefits for New Yorkers with disabling conditions to health plans that have little to no experience coordinating their care or engaging them with support,” said Lauri Cole, Executive Director of the NYS Council for Community Behavioral Healthcare. “The potential consequences associated with a carve in of these benefits is likely to include fragmented care, clients who get lost in a complicated paperwork and prior authorization shuffle and possibly, loss of life and front page headlines,” she said. Toni Lasicki, Executive Director of the Association for Community Living, echoed these concerns. “Experience has shown that people with serious and persistent psychiatric disabilities need to work with people they know and trust, people who visit them often, people who follow up, who take them to appointments, and who help them manage crises and avoid costly relapses.” Standing with the mental health advocates at the news conference was John Coppola, Executive Director of the New York Association of Alcoholism and Substance Abuse Providers. “People with substance use disorders are working successfully with treatment, prevention and recovery programs that are already helping NYS to reduce its deficit,” he said. “We are very worried that care will be interrupted and people will relapse if managed care companies are not required to include all OASAS licensed programs on their service provider panels.” As the MRT began evaluating its first set of proposals, both alternatives were on the table. Proposal #91 called for a “Carve-In” approach in which individuals with behavioral health disabilities would join generic Medicaid Managed Care plans. Proposal #93 was for the implementation of Regional Behavioral health Organizations, as proposed by the coalition. In addition, several other proposals under consideration by the MRT would affect Article 31 community behavioral health clinics. One proposal (#19) would eliminate the indigent care pool for Diagnostic and Treatment Centers (D&TCs) for an estimated savings of $54 million. The proposal notes that “Elimination of Indigent Care may cause eligible D&TCs to reduce services to the uninsured or to be closed thereby forcing patients to higher cost venues such as hospital emergency rooms for their care. Currently a Budget Proposal is contained in the extension of the 1115 Managed care waiver to request federal participation in funding this pool. This along with the state dollars would have increased funds available to approximately $110 million annually. The additional funding would go to support uncompensated care for freestanding article 31 clinics to replace funds currently provided as deficit financing Comprehensive Outpatient Program Services (COPS) as well as provide additional coverage to Article 28 D&TCs for uncompensated care.” Another proposal (#26) would establish “two threshold levels based on the number of clinic visits a given patient receives during a 12 months period. The mental hygiene agencies are the Office of Mental Health, the Office of Alcoholism and Substance Abuse Services, and the Office for People With Development Disabilities. Mental hygiene clinic claims that exceed the lower threshold would be paid at a 25% discount.” The proposal cites the following proposed threshold values for visits in a 12-month period: • OASAS 65/85 • OMH 30/50 • OPWDD 90/120 Other proposals would significantly reduce personal care (#2 and #7); require prior authorization for anti-depressants, atypical snitpsychotics, anti-retrovirals and immunosupressants (#32) and limit prescription drug benefits in other ways (#35, #57, etc.). EARN YOUR MPA IN ONE YEAR Our Master’s of Public Administration is designed to equip people in the non-profit sector with the essential executive and analytical skills necessary to become effective leaders. Learn about our unique “Constructive Action”approach to learning and use your knowledge to bring about change within your organization as you progress towards completing your degree. This one year degree focuses on your work and accommodates your work schedule. Check our website for a list of admissions events focused on undergraduate and graduate programs to further you, your degree, and your career advancement. THINK MCNY and think how you can change the world! Master’s of Public Administration Open House Wednesday, March 9, 6pm-8pm Think MPA.Think MCNY. Call 1.800.33.think Or Visit MCNY.EDU 431 Canal Street (off Varick) Military Veterans, ask about Operation Tuition Freedom. MCNY ADMITS STUDENTS OF ANY RACE, COLOR AND NATIONAL OR ETHNIC ORIGIN. MCNYRE936_NYNP_Ad_Jan_R2.indd 1 2/22/11 9:59 AM
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