CDPAANYS SFY 2016-17 Budget Summary

Budget overview The 2016-17 budget is $95.885 Billion in State Operating Funds, an increase of $1.603 Billion, or 1.7%, over last year’s budget. The 2016-17 budget is $145.303 Billion, in All Funds, an increase of $1.71 Billion, or 1.2%.

Major Policy Priorities Governor Cuomo identified the following major policy and budget priorities in his budget: Use $2.3 Billion from one-time payments in AG settlements to: Thruway Toll Stabilization – this will invest $700 million in the Thruway to maintain tolls at the current level until 2020 Transportation capital plan – A $200 million investment this year will fund a multi-year $22 Billion to upgrade roads, bridges and other infrastructure. Homelessness and affordable housing – The Governor will spend $640 million to invest in a multi-year $20 billion program to create and improve affordable housing to end homelessness. Invest $120 million in the Environment Protection Fund to bring it to $300 million total. $25 million for an anti-poverty initiative. $255 million for Upstate Development.

Major Policy Proposals (cont’d) $300 million in tax breaks for small businesses Expand the Jacob Javits Center Multi-year project for rebuilding Penn Station Minimum wage increase to $15 in 2018/2021 (more later) Paid Family Medical Leave (more later)

Health Budget All funds Medicaid spending decreases by $348 million, or -0.5%, to $63.308 billion. Medicaid Global Cap spending increases by $588 million, or 3.4%, to $17.692 billion. Non-Medicaid DOH spending increases by $131 million, or 3.2%, to $4.183 billion.

Specific Medicaid Proposals of Interest to FIs The Medicaid Global Cap, and the corresponding “super-powers” of the Department, are continued. There is a $78 million investment in overtime and travel. This is for home care and CDPA. It continues the $0.34 per hour funding. There is still no mechanism identified to pass that through. Individuals will no longer be eligible for MLTC unless they require a nursing home level of care.

Specific Medicaid Proposals of Interest to FIs Early Intervention is inserted into prompt-pay law with a clause that only provides the insurer 15 days, instead of 30, to identify any problems in the claim. Spousal Refusal, or the right of the spouse to refuse to pay for long-term care benefits to avoid impoverishment, is eliminated. Transportation is taken out of the MLTC benefit.

Non-Medicaid Proposals of Interest to FIs – Minimum Wage Statewide (Not NYC) New York City only Eff. July 1, 2016 - $9.75 Eff. Dec. 31, 2016 - $10.75 Eff. Dec. 31, 2017 - $11.75 Eff. Dec. 31, 2018 - $12.75 Eff. Dec. 31, 2019 - $13.75 Eff. Dec. 31, 2020 - $14.50 Eff. Dec. 31, 2021 - $15.00 Eff. July 1, 2016 - $10.50 Eff. Dec. 31, 2016 - $12.00 Eff. Dec. 31, 2017 - $13.50 Eff. Dec. 31, 2018 - $15.00

Non-Medicaid Proposals of Interest to FIs – Minimum Wage The minimum wage is not funded in Medicaid or any other government funded arena. CDPAANYS estimates the first year cost to FIs to be $33.5 million. Governor Cuomo’s office said their official sentiment is that the cost is “nominal enough” in the first year that Medicaid does not have to be adjusted.

Non-Medicaid Proposals of Interest to FIs – Paid Family Medical Leave Funded by payroll tax on employee through worker’s compensation payment Will begin by covering 1/3 of wages, escalating to ½ of wages when fully implemented. Caps at 1/3 to ½ average weekly wage (currently $1,266) Employees may take up to 12 weeks of Paid Family Medical Leave per year. May be taken for: To provide for care of a family member made necessary by a serious health condition; To bond with a child during the first 12 months after birth, adoption, fostering, or other; or To be with a family member on leave from active duty or who has been called to active duty.

Non-Medicaid Proposals of Interest to FIs – Paid Family Medical Leave (cont.) Serious health condition is defined to mean: “illness, injury, impairment, or physical or mental condition that involves inpatient care in a hospital, hospice, or residential health care facility, or continuing treatment or continuing supervision by a health care provider and requiring assistance to perform the activities of daily living.” This definition would exclude taking care of a family member who utilizes CDPA.

Issues not addressed in SFY 2016-17 Budget Reimbursement Funding for minimum wage Direct care ceilings adjustments Trend factor restoration Controls on managed care to ensure adequate payment Full funding for overtime and travel Licensure or Certification Cash and counseling as a program option Study to determine adequate wages and reimbursement in home care and CDPA

Discussion Identifying Issues of concern and providing guidance to advocacy committee