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Elimination of Fiscal Intermediaries In Medicaid Funded Program Brings Potential Job And Funding Losses To Rockland Nonprofits
By Andy Milone
The organizations responsible for serving the chronically ill and physically disabled are expecting to be demoted from homecare “providers” of an important Medicaid program to “subcontractors.” The shift, a result of legislation passed by New York State, will impact jobs and funding for several Rockland nonprofits, including BRIDGES.
The Consumer Directed Personal Assistance Program (CDPAP), funded through Medicaid, allows eligible participants to choose their own caregivers, including family members who may not have training or certifications. Nonprofits like BRIDGES serve as “fiscal intermediaries” under the program and perform wage and benefit processing for personal assistants providing home health services. These agencies say the closeup and local approach has greatly benefitted their clients.
But Gov. Kathy Hochul disagrees, having argued a more centralized approach is needed to rein in abusive financial spending and mismanagement, and to potentially save the state $500 million.
The change, included in the recently passed fiscal year 2025 budget bill, will pose difficult questions for the future of nonprofits like BRIDGES, Rockland Independent Living Center. For starters, the agency will have to decide whether to give up its high-profile spot at the Palisades Center because funding from the Consumer Directed Personal Assistance Program has sustained the agency and allowed it to pay for its tenancy.
Leadership of the nonprofit may also go as far as taking legal action and advocating for a different approach to try to halt replacing it and other nonprofits with a yet to be determined larger entity.
“The subcontracting model means that we are no longer responsible for compliance,” said BRIDGES’ CEO/Executive Director Carlos Martinez. We’re no longer responsible for payroll. We’re no longer responsible for billing. All we’re left with is providing intake services, answering first-hand questions, and helping people apply for the program. It’s destructive; we’re becoming the middleman.”
For now though, it’s business as usual for BRIDGES. No guidance has been provided to fiscal intermediaries and everyone is scrambling to interpret the bill. What they do know is a deadline of April 1, 2025, for ceasing their current role under Senate Bill 8307, passed hastily on April 20 – what opponents of the changes say will lead to less effective services. New York will utilize a single Statewide Fiscal Intermediary (SFI), defined in the budget as “an entity that provides fiscal intermediary services and has a contract for providing such services” with the New York State Department of Health.
“This is coming extremely fast and was not necessarily fully debated through this budget and was developed really in the last week or week and a half,” said Sen. Bill Weber (R-38), who voted against the bill. “We’re extremely worried that they won’t get the care they’re accustomed to.”
Hochul and the Democratic majority say it will be a major cost savings measure to the tune of $500 million for a growing program and will lend more oversight over some providers allegedly responsible for fraud and abuse of funds.
“I think there’s fraud and abuse in every system, but that doesn’t necessarily mean you should throw out the baby out with the bath water,” said Weber. “If there are bad actors, let’s identify them and deal with them, let’s put more audit checklists in place.”
Martinez estimates 30 to 40 of the approximately 400- 700 fiscal intermediaries statewide are in Rockland County.
Ten thousand New Yorkers may lose their jobs – including 15-20 people at BRIDGES, who work in quality assurance and human resources, Martinez said. The CDPA program represents 80% of what BRIDGES does as an organization. That’s among more than a hundred or perhaps several hundred who could be laid off in the county, the CEO said.
Martinez said he believes more than 4,000 clients are served under the CDPA program in the county through various organizations.
A dozen of the state’s fiscal intermediaries founded the program over a quarter century ago and contract with Department of Social Services. But there are others, according to Martinez, directly contracting with the clients’ health plans and not listed in readily available public records.
BRIDGE’s CEO is not against cutting down the list of intermediaries but would like to see a more reasonable number left over. He proposes that each county have one act independently on its behalf.
“The law requires us to provide a cost report,” he said. “The cost report is your transparency mechanism that allows you to understand how each FI is using and spending Medicaid dollars related to this program. Out of 700 FIs, only 309 of them filed one. That is your number one key and responsible way to eliminate over 400 FIs off the bat.”
The CDPA program represents closer to 3 percent of the health offerings at Jawonio, according to CEO Randi Rios-Castro, meaning the impact on the dozens of part-time and full-time personal aides won’t be as significant. However, she was thinking more about the alternative programs for the clients who may no longer gain access to a homecare program as a result of the change.
“What’s going to happen to them?” she asked.
The head of the New City provider of lifespan services said it is a tough spot for the county’s aging population when nursing homes and assisted living facilities are “unaffordable” to most people.
Rios-Castro also said it’s not fair when the state’s growth and resulting cost was somewhat self-inflicted for good reason because home care workers weren’t paid enough.
“They’re penalizing providers because they lifted the minimum wage,” she said about state officials.
