web analytics
May 28, 2015 / 10 Sivan, 5775
At a Glance
Sections
Sponsored Post


A Step Backwards: Disturbing Changes to the NY State Medicaid Waiver in the Works


Now all those gains are in jeopardy, due to the enormous pressure being exerted by the federal government on the New York State government to reduce spending on services to the MRDD population. In response, the state is proposing to restructure the way that all current services are delivered to individuals who qualify for Medicaid Waiver, including basic health care services that are identified in their IEPs. The plan is euphemistically named the “1115 People First Waiver” and the cost of its development and implementation is being funded by the federal government.

The plan calls for many of the current functions of the New York State Office for People With Developmental Disabilities (OPWDD), which was formerly known as OMRDD, to be outsourced to the DISCOs, which are not under direct government control.

Services from the Lowest Bidder

The DISCOs are supposed to offer Medicaid Waiver qualified individuals the full range of services to which they are legally entitled, oversee the quality of those services, and pay the actual costs of providing them. In return, the DISCOs would receive a capitation (flat rate) per person payment provided by the government. This is very different from the current fee-for-service model, under which community service providers receive payments from the government that are directly related to the historic operating costs of their specific facilities and programs. The more costly the program has been to operate, the higher the reimbursement rate they received.

By contrast, the DISCOs will be paid a flat per-person rate established by the Cuomo administration for a standard spectrum of services for individuals with the same category of diagnosis. The DISCOs will subcontract the actual delivery of the services to community providers, with whom they will negotiate the reimbursement the provider will actually receive. Current community service providers will have to compete with one another for DISCO subcontracts.

Since the DISCOs pocket any difference between the flat rate the state pays them and what they pay the providers, the DISCOs will choose service providers largely on the basis of lowest cost, and in some cases, will be providing the services themselves. Over time, the higher cost providers will be eliminated, even if they provide higher quality services, and the quality of care will inevitably suffer.

Care recipients are supposed to be offered a choice of DISCOs, but given the powerful incentives for each DISCO to cut costs built into the new system, it is doubtful that the choices will be meaningful. Furthermore, since the DISCOs are expected to monitor themselves, the ability of care recipients and their family members to file effective complaints will be significantly reduced.

The State’s Real Priorities

The preliminary 1115 Waiver plans published by New York State talks about provisions to deal with these problems, but government officials have made it clear to community providers that the state’s top priority is to cut the cost of services, while paying only lip service to the issues of maintaining service quality and meaningful patient choice.

The state’s main goal is clearly laid out in the report of the fiscal team designing the 1115 Waiver (see reference 1): “In recent years, Medicaid expenditures for individuals with developmental disabilities have grown at twice the rate of inflation and three times faster than personal income. . .

“The 2.8 percent annual growth in [the number of] individuals seeking services is due to factors largely outside the control of State government and is likely to continue indefinitely.”

The aim of the Waiver initiative, therefore is, “to meet individuals’ needs, but at lower cost. . . [by implementing] a capitation payment model to achieve these goals.”

State officials have said that the current system of 750 groups providing services is financially unsustainable, and admit that they hope to eliminate the higher cost providers with the new 1115 Waiver system.

The state began implementing planning and evaluation for the new system in November, and expects to launch pilot programs under the system and test DISCO operations in the latter part of 2012 (for the full 1115 Waiver timetable, see reference 2).

Unfortunately, what we know about the 1115 Waiver plans so far serves as a warning that many of the hard earned gains that have been achieved for the MRDD population since Willowbrook are now in jeopardy. Time is running out. The citizens of New York State must be alerted about how the 1115 Waiver changes will hurt all individuals with special needs. We must join together to protest and speak out against them, before it is too late.

Sidebar:

Reference 1: http://www.opwdd.ny.gov/2011_waiver/images/fiscal_final_report.pdf Reference 2: http://www.skipofny.org/upload/OPWDD_1115_Waiver_Background.pdf Reference 3: The New York State branch of The Arc, a disability activist group, has provided a web page with layman’s definitions of the terms used by New York State in discussing the 1115 waiver - http://blog.nysarc.org/2011/08/10/understanding-the-1115-waiver-terminology-guide/ Reference 4: New York State has created a “People First Waiver” web page invites the participation of the public in the process of its development. It also accepts e-mail addresses for notification of further waiver developments: http://www.opwdd.ny.gov/2011_waiver/

About the Author:


If you don't see your comment after publishing it, refresh the page.

Our comments section is intended for meaningful responses and debates in a civilized manner. We ask that you respect the fact that we are a religious Jewish website and avoid inappropriate language at all cost.

If you promote any foreign religions, gods or messiahs, lies about Israel, anti-Semitism, or advocate violence (except against terrorists), your permission to comment may be revoked.

No Responses to “A Step Backwards: Disturbing Changes to the NY State Medicaid Waiver in the Works”

Comments are closed.

Current Top Story
Ben & Jerry's new flavor: Bernie Sanders
Ben & Jerry’s Launches New Flavor: Bernie Sanders
Latest Sections Stories
Road sign in Russian and Yiddish greeting visitors on the road just outside Birobidzhan. (photo by Ben G. Frank)

Birobidzhan railway station sign is the world’s only one spelling the town’s name in Yiddish letters

Ayelet Shaked

She’s seen as a poster child for The Jewish Home’s efforts to reach beyond its Orthodox base.

Teens-Twenties-logo

Girls don’t usually learn Gemara. Everyone knows that.

Lewis-052215-Jewish-Soldiers-logo

Mordechai and his men shared a strong mutual loyalty.

“Can I wear tefillin in the bathroom?” That was the question US Private Nuchim Lebensohn wrote to Mike Tress, president of the Agudath Israel Youth Council, in a letter dated November 18, 1942. Lebensohn was not your typical young American GI. Polish by birth, he was forty-three years old and married when he was drafted […]

To what extent is your child displaying defiance?

This therapist kept focusing on how “I could do better,” never on how we could make the marriage work.

Mistrust that has lingered after the fiasco in Ferguson, Missouri, has edged the issue forward.

“The observance of a kosher diet is a key tenet of Judaism, and one which no state has the right to deny,” said Nathan Diament, executive director for public policy of the Orthodox Union.

Two weeks of intense learning in the classroom about Israel culminated with Yom Ha’Atzmaut. Students attended sessions with their teachers and learned about history, culture, military power, advocacy, slang, cooking, and more.

The nations of the world left the vessel to sit rotting in the water during one of the coldest winters in decades and with its starving and freezing passengers abandoned.

Rabbi Yisroel Edelman, the synagogue’s spiritual leader, declared, “The Young Israel of Deerfield Beach is looking forward to our partnership with the OU. The impact the OU has brought to Jewish communities throughout the country through its outreach and educational resources is enormous and we anticipate the same for our community in Deerfield Beach as well.”

Our goal here is to offer you recipes that you can make on Yom Tov with ingredients you might just have in the house. Enjoy and chag sameach!

More Articles from Yaakov Kornreich

Today, millions of members of the baby boomer generation are being confronted with the new realities of aging in America. Many now reaching the traditional retirement age of 65 are still fit and vigorous and do not consider themselves to be old. Thanks to medical science, 60 has indeed become the new 40, and most can look forward to years — and perhaps decades! — more of life in relatively good health. Yet, many do not want to retire.

Between 1997 and 2008, the number of children diagnosed with autism spectrum disorders (ASD) increased almost fourfold, according to the National Health Interview survey. The 2007 National Survey of Children’s Health indicated that 1.1 percent of all children born in this country are on the autism spectrum.

As Rabbi Meyer Waxman discusses elsewhere in this issue, more elderly parents are being forced, by circumstances, to move in with their adult children, as are more young adults who find themselves compelled to move back into their parents’ home. More adults have become part of the sandwich generation, as members of the six million American households today that span three or even four generations.

Fundamental and far-reaching changes are coming that will have a profound effect on every individual in New York State who receives services under the current system for caring for individuals with developmental disabilities.

The worldwide diabetes epidemic and its related precursor, obesity, are the fastest growing public health menaces of the 21st century.

Printed from: http://www.jewishpress.com/sections/health/a-step-backwards-disturbing-changes-to-the-ny-state-medicaid-waiver-in-the-works/2012/03/18/

Scan this QR code to visit this page online: