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NYSACRA/NYSRA 2017-2018 NYS Budget Proposal Analysis

Here is the NYSACRA/NYSRA analysis of Governor Cuomo’s proposed budget for 4/1/17 to 3/31/18.

I will share more as it becomes available.

Bill

Proposed 2017-18 Executive Budget

Joint Preliminary Analysis — UPDATE
Friday, January 20, 2017

This updates the report we issued Wednesday providing our preliminary analysis of Governor Andrew Cuomo’s proposed 2017-18 Executive Budget. The update contains additional information for the proposed budgets for the following state agencies: OPWDD, OMH, OASAS, DOH, SED, OCFS DOL and other.

Clarification and additional details on the OPWDD budget were provided Wednesday during an OPWDD Budget briefing conducted by Executive Deputy Commissioner Helene DeSanto and Deputy Commissioner Kevin Valenchis. The NYSACRA and NYSRA Executive staff participated in the OPWDD Budget briefing. OPWDD followed closely the Budget presentation found in various Budget materials on the NYS Division of the Budget’s website, and we have no corrections to the information we shared yesterday. OMH, OASAS and other state agencies have not yet held their briefings.

Several areas that deserve additional mention from our preliminary analysis (and several prompted by questions from us and other participants on the briefing with OPWDD officials), are as follows:

Uncertainty of Federal Funding Environment “Escape Valve”

The Executive Budget legislation includes contingency language to authorize the State to reduce certain local assistance payments by a uniform amount in the event that Federal aid is reduced from planned levels. This could impact all Medicaid funded supports if Federal funding reform (Medicaid; SSI, etc.) reduces eligibility or payment levels.

Adequacy of Minimum Wage Resources and Other Workforce Related Funds

During Thursday’s budget briefing with OPWDD, we questioned whether the $17 Million referenced in the 2018 Budget proposal was adequate to address the direct impact of the continuing roll-out of minimum wage requirements on Department of Mental Hygiene agencies. Deputy Commissioner Valenchis responded that it appeared sufficient based upon the State’s preliminary work force survey and analysis, and that there would likely be yet another survey later this year (summer was mentioned) to further refine the anticipated impacts and need. The $17M is identified in the Governor’s budget for the Mental Hygiene agencies to cover the direct cost of increasing the wages to comply with the next increase in the minimum wage set to take place in 2018. $14M of that is identified for OPWDD, but this does nothing to address the living wage investment the #bFair2DirectCare campaign requested – it only addresses the direct impact of bringing staff not currently making the new mandated minimum up to the new mandated minimum in 2018. The Governor’s failure to include the $45M living wage prompted a response from the #bFair2DirectCare campaign on Wednesday. Click here to view the #bFair2DirectCare press release.

The Governor’s proposal also holds back on providing resources for the statutorily required .8% estimated COLA for the human services sector. Rather, the Governor proposes to amend the law to “notwithstand” this provision, and forego this expenditure, totaling $40M across all impacted sectors.

Efficiency Merger Pool

In response to several questions relating to work force compensation needs, OPWDD stressed an evolving plan to establish a type of support pool of funding designed, in part, to address the work force needs of providers, and particularly those in fiscal distress who are or will be involved in mergers prior to, and during, the IDD’s field entry into Managed Care. Details surrounding how such a pool would be initially primed, its overall size, and specific use priorities were not described in any specificity. Deputy Commissioner Valenchis did say, however, that one priority for pool resources would be to shore up work force requirements and wage equity that might exist between merging entities.

Global Medicaid Cap Resources/Managed Care Time Frames

Resources from the DOH Global Cap will be provided to support the initial start-up costs of transitioning the OPWDD system from fee-for-service to managed care. The first phase of this is the creation of Care Coordination Organizations, planned to begin operation in late 2017. Importantly, the budget documents specifically state that “developing and implementing a managed care system for OPWDD requires short-term investments for start-up and administration costs at both the state agency and provider agency levels, which will be supported by DOH Global Cap resources.” Voluntary enrollment into managed care would begin in 2019, with the entire IDD population phased in over the ensuing five year period. Importantly, OPWDD officials advanced that any savings associated with managed care implementation would be reinvested back into the IDD field.

Overall, OPWDD officials described the 2018 Executive Budget proposal as quite positive for the IDD field. They pointed to the following:
Whereas State Funds for the entire 2018 Budget were held to a 1.99 percent increase (below the Governor’s self-imposed 2 percent growth cap), OPWDD’s Budget demonstrates a 3.3 percent growth.
Their outreach efforts to assess residential need have resulted in a multi-year residential opportunities commitment over the next three years to ensure about 4,900 certified and 1,400 non-certified residential opportunities. And
The commitment to use Global Cap resources for the IDD field’s entry into Managed Care is a major accomplishment.

State Department of Labor (DOL) Exempt Position Overtime Resources
Responding to a concern that the State DOL rules that affect overtime payments to exempt class positions have commenced on December 31, 2016, OPWDD confirmed that there is no funding increase in the Budget proposal to address any associated impact. There is no evidence of resources to address this in other areas of the budget we have analyzed, either. This is yet another unfunded requirement human services providers will face unless the Federal and State governments move to reverse their positions (or the eligibility issue is reversed via ongoing litigation).

NYS Office of Mental Health Budget and Initiatives
Governor Cuomo proposes $3.7B All Funds appropriations for 2017-18 for OMH’s system that supports more than 700,000 New Yorkers with mental health needs. This is $102M / $107M (appear to be conflicting numbers) from 2016-17, primarily reflected in capital and investments in community-based services. This includes:
$11M to “expand community services based on regional needs reflecting stakeholder input.”
“280 community-based, scattered-site supported housing units … by reconfiguring 140 state-operated residential beds, which are less integrated and most costly to operate.”
“$10M to enhance support for existing residential programs … supported housing and single residence (SRO) programs.”
OMH will redesign administration and standardize oversight of “service dollars (, which) are funds available to meet the service plan needs of … clients by supporting a variety of emergency and non-emergency expenses.”
OMH will transform all 85 state-operated clinics to “reduce overlap of services and ensure that clinics are operating at optimal patient capacity to address community need.”
Revamp Hutchings (Syracuse) Children & Youth Services to achieve efficiencies and work more closely with Article 28 hospitals that could deliver OMH services, expand bed capacity, and improve coordination.

NYS Office of Alcoholism and Substance Abuse Budget and Initiatives
The Governor’s proposal for OASAS totals $693M All Funds appropriations, for this agency that supports 240,000 New Yorkers with substance use disorders and gambling problems. This is $37M increase over 2016-17, most of which is dedicated to address the growing heroin and opioid epidemic. Major components of the OASAS budget include:
80 new residential treatment beds to be run by not-for-profit providers
600 additional Opioid Treatment Program slots, which provide medication, like buprenorphine
Funding to support 10 new regional coalitions and partnerships for families, service providers, educators, law enforcement, state agencies and local leaders to collaborate on prevention and treatment
Funding to support 10 new Family Support Navigator programs to assist and inform people seeking treatment and their families of options for insurance coverage and other treatment options
Funding to support 10 new Peer Engagement Programs, aimed at helping individuals in need of treatment make connections from hospital emergency rooms to the treatment system.
Funding for 8 new Adolescent Clubhouses
Funding for 5 new Recovery Community and Outreach Centers
Funding for 10 24/7 Urgent Access Centers, providing around the clock access to treatment
Funding for 2 pilot Recovery High Schools, which provide a substance-free and supportive environment within existing schools.

Department of Health Budget and Initiatives
Growth within the Medicaid global cap, under which OPWDD services do not fall, is tied to the 10-year average of the Medical Consumer Price Index, which currently stands at 3.2%. State share of those Medicaid global cap funds are proposed to rise $567M to $18.259B in 2017-18. In addition to the $225M discussed earlier for the minimum wage, the DOH budget includes:
Discussion of moving toward care management for all continues to be a stated goal of DOH for 2017-18, and mental health, substance use disorders, and developmental disability supports are specifically outlined as goals for this initiative moving forward.
$334M is proposed to continue to be made available to critical health care providers through the VAP and VBP programs, including use of these funds to provide transitional operating assistance to financially distressed providers to facilitate redesign of their systems, improve their financial stability, and enhance the availability of vital health care services. These funds have never traditionally been available to providers that primarily provide support to people with disabilities.
Discontinue an underutilized COLA targeted to direct care workers and direct service providers in DOH and State Office for the Aging programs.
$500M in additional capital supports for essential health care providers, including a minimum of $30M for community-based providers, to support capital projects, debt retirement, working capital, and other non-capital projects that facilitate health care transformation.
Creation of the Health Care Regulation Modernization Team, modeled after the MRT, “to review existing health care regulatory structures and recommend changes, including regulations involving the intersection of physical health and behavioral health. The goals of this effort will be to: increase the speed with which providers can complete construction projects, support the delivery of services across an integrated system of care; modernize regulations that serve the core purposes of ensuring access and protecting patient safety; use achievement of quality and other performance outcomes as factors in determining the frequency and extent of inspection activities; and create an environment where the State and providers can collaborate to further explore new and innovative models of care.”

NYS Education Department Budget and Initiatives
The Governor recommends a $35.1B allocation for SED. While the SED budget proposal includes many items that are not covered in this analysis, it is important to note that the SED budget proposal includes:
Aid to Localities funding for ACCES-VR that would decrease by $1M.
Establishing an independent Inspector General to oversee and investigate allegations of corruption, fraud, criminal activity, conflicts of interest, or abuse.

NYS Department of Labor Budget and Initiatives
In total, the Governor recommends $3.69B for DOL, “reflecting a decrease of $117M from FY 2017, primarily reflecting reductions in estimated unemployment insurance claims…” Among the noteworthy DOL initiatives in the budget are the following:
$50M allocation over 5 years to extend the Urban Youth Jobs Program and expand it statewide.
Changes to allow unemployment insurance claimants to receive partial UI benefits based upon a claimant’s weekly earnings, rather than days worked, allowing a claimant to earn up to $100 or 40% of the available full UI benefit, whichever is greater, before any reduction in benefit.

NYS Office of Children and Family Services Budget and Initiatives
The Governor proposes $3.9B for OCFS, a decrease of $90M. Among the many OCFS initiatives in the proposed budget are:
“Raising the age of juvenile jurisdiction from age 16 to age 18.” This change is estimated to increase costs to $191M in 2022, and necessitate capital investments of $110M.
Aid to Localities funding for the Commission for the Blind is proposed to decrease $50K to $350K.

Economic Development
As part of the Governor’s economic development investments is $750M for a 7th round of Regional Economic Development Council funding. This includes $150 for high value regional priority projects and $70M in state tax credits set aside from the Excelsior Jobs tax credit program.

NYSACRA and NYSRA staff continue to research further details surrounding the Governor’s 2018 Budget proposal and will be attending other briefings from State agencies where, hopefully, more Budget intelligence will be provided.