[NYAPRS Enews] Budget: SSI COLA Cut, MBI Premiums Begin, End Part D Medicaid Wrap

[Harvey Rosenthal]

              STATE BUDGET REPORT

 

To:            NYAPRS Members and Friends                       December
17, 2008

From:        Harvey Rosenthal        Matt Canuteson           

 

Re:   Deeper Look at Proposed NYS 2008-9 State Budget

          SSI COLA Cut for New Yorkers with Disabilities; MBI Premiums
Begin; 

          Elimination of Medicaid Wrap Around for Medicare Part D
Beneficiaries;

More Details on $1.4m New Peer Support Groups Center and Innovation
Funds, 

$5m CDT Restructuring Initiatives, $12 Employment Medicaid
Infrastructure Grant; 

Indigent Care Pool for Mental Health Clinics

 

A further look at the budget has yielded more details about both some
very harmful proposals and positive provisions, as follows: 

 

HARMFUL

SSI Cut for New Yorkers with Disabilities

"The 2009-10 Executive Budget reduces the 2009 state benefit for SSI
recipients living in the community by between $16 and $28, effective
June 1, 2009. For individuals living alone, the benefit will be reduced
by $24, from $761 to $737. However, a recipient's total monthly SSI
benefit will still be $9 to $34 higher than their 2008 monthly benefit,
as a result of the offsetting impact of a 5.8 percent cost of living
increase to the federal benefit. (2009-10 Savings: $84 million; 2010-11
Savings: $79 million)"

NYAPRS is already reaching out to our friends in the cross disability
advocacy movement to fight these cuts. A similar proposal put forth by
the Pataki Administration was met with vigorous protests capped by a
dramatic 'take over' of the relevant legislative budget committee, which
led to the prompt restoration of this cut. Stay tuned!

 

Delay Implementation of Prison Reforms

Under the Special Housing Unit (SHU) Exclusion bill, the Department will
open a new 100-bed Residential Mental Health Unit at the Marcy
correctional facility, and has requested time to evaluate the
effectiveness of the new unit prior to undertaking further expansion." 

As a result, "the budget would delay for 3 years significant statutory
investments beyond those mandated by a legal settlement with Disability
Advocates, Inc. (DAI) concerning mental health services in prison ($11.4
million). The DAI settlement already requires additional funding for
special treatment beds, transitional intermediate care beds, and a
residential mental health unit (RMHU). The SHU law currently requires
construction of additional RMHU facilities, more training, and
additional assessments in more facilities. Postponing the effective date
of the SHU law would allow additional time to determine the
effectiveness of the programs and funding associated with the DAI
settlement before expansion of these new services. Postpones hiring 86
new staff. (2009-10 Savings: $23 million; 2010-11 Savings: $33 million) 

This will also result in a deferral of 388 additional DOCS positions.
(2009-10 Savings: $11 million; 2010-11 Savings: $15 million) 

NYAPRS and our friends in Mental Health Alternatives to Solitary
Confinement will be strongly opposing these measures to compromise the
promise made to relieve the suffering of prisoners with psychiatric
disabilities. 

 

Elimination of Medicaid Wrap Around for Medicare Part D Beneficiaries

"Wrap-around coverage in EPIC for drugs covered by Medicare Part D will
be eliminated. Wrap-around coverage in Medicaid for four remaining
categories still covered will also be eliminated. Wrap-around coverage
will continue for drugs not covered by Medicare Part D (e.g.,
barbiturates, benzodiazepines). (2009-10 Savings: $52.7 million; 2010-11
Savings: $72.5 million)"

 

NOTABLE

Start Collection of Medicaid Buy In Premiums

"Monthly sliding-scale premiums of $25 to $75 for the Medicaid Buy-In
program for the working disabled will be instituted in order to meet
federal requirements. (2009-10 Savings: $0.3 million; 2010-11 Savings:
$0.4 million)" 

Establish Drug Utilization Review. 

Standards developed by the Office of Mental Health governing the
dispensing of psychotropic drugs will be used in the Medicaid program.
(2009-10 Savings: $1.8 million; 2010-11 Savings: $3.9 million)

 

POSITIVE

More Details on New Peer Support Groups Center, Incentive Funds for
Innovative Peer Programs 

With strong backing from Commissioner Hogan and Bureau of Recipient
Affairs Director John Allen, OMH is creating a Peer Support Groups
Training, Technical Assistance and Resource Center to "promote and
support peer run organizations to leverage further transformation in the
system. The full annual value of the initiative is $1.4 million. The
Center will provide a range of technical assistance, training, tools and
resources for peer run organizations. In addition, some of these funds
will be used to "support annual grant awards to encourage innovation and
growth of peer run organizations."

 

CDT Restructuring Initiatives

OMH is implementing the Continuing Day Treatment (CDT) restructuring
initiative to "reduce existing reimbursement levels, enhance the
program's service requirements, reconfigure Medicaid rates from hourly
to half day/full day and transition hospital-based CDTs to a consistent
methodology rather than reimbursement for a threshold visit."

OMH is poised to redirect a portion of the estimated $5 million in
reduced CDT utilization savings "to address potential reductions in
service capacity by supporting conversions and/or expansions to
alternative programs like PROS, clinics and peer operated programs."

 

$12 Million Employment 2 Year Medicaid Infrastructure Grant

Spurred by last year's Employment Campaign, New York has successfully
applied for federal funding to advance the employment of New Yorkers
with disabilities. The funds come in the form of a Medicaid
Infrastructure Grant which is available to enhance their efforts to
support working individuals with disabilities. As of 2008, over 40
States and the District of Columbia are participating in this program. 

As we had advocated, OMH will be the lead agency for this cross
disability effort and will oversee, in partnership with Cornell
University and the Burton Blatt Institute, the use of these funds to:
"build comprehensive cross-agency, sustainable, coordinated systems of
support and services to advance employment for individuals across the
full spectrum of disabilities and support the go al of removing barriers
to employment and create lasting improvements for New Yorkers with
disabilities."  

The funds will amount to $6 million in 2009, $6 million in 2010 and
possibly more in the future. 

 

Increase Indigent Care Funding for Community Clinics

"Subject to a federal waiver, the indigent care pool for diagnostic and
treatment centers will be doubled in size ($55 million to $110 million)
and expanded to include clinics licensed by the Office of Mental
Health." 

 

Restructure Sex Offender Management Treatment Program

"The Office of Mental Health (OMH) would shift treatment for sex
offenders from an inpatient psychiatric model to treatment standards
comparable to those used in other states which require lower staffing
ratios; encourage courts to use video-conferencing to reduce costly
transportation and security issues; allow certain respondents to remain
in prison or on parole until their civil confinement trials; and reduce
planned staff by 217 jobs ($11.7 million)." 

 

Reduce OMH Adult Inpatient Capacity

Reduce state-operated inpatient capacity by nearly 11 percent (450
beds). Approximately two-thirds of the 450 bed reduction would result
from shifting patients to a less intensive, medically appropriate
service delivery model to be provided within OMH facilities, while 150
beds would be closed by shifting patients to more appropriate and less
costly outpatient/community services saving $6.1 million in 2009-10. No
patient will lose services. These actions will lower the state workforce
by a net of 153 positions, approximately 80 of which would be reduced
through attrition. Over 75 percent of the gross savings from the
restructuring are being reinvested in these other mental health services
(approximately $38 million of $50 million is being reinvested on a full
annual basis). Additionally, aggressive controls on hiring and
non-personal service costs will save another $10.1 million. (2009-10
Savings: $16 million; 2010-11 Savings: $23 million) 

 

 

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