On February 18th, the New York State Department of Health (DOH) published the Second Quarterly Update for spending proposals to enhance home and community-based services (HCBS) using the enhanced federal matching funds available under Section 9817 of the American Rescue Plan. DOH now estimates that it will be eligible for about $2.5 billion in state funds equivalent (SFE), up from $2.25 billion in the first quarterly update. Since the portion of SFE funds that are spent on eligible Medicaid services may be matched by further federal funds, DOH estimates that a total of $4.8 billion will be available for investments to improve HCBS.
The Second Quarterly Update also contains new information on the current status of proposals. Almost all of the original proposals (37 of 39) have now been approved by CMS, although most of them (32) require an additional federal authority to implement, such as a State Plan Amendment or state-directed payment preprint. Of these, 12 approvals have been received. Notable updates on the largest projects include:
- Transform the Long-Term Care Workforce and Achieve Value-Based Payment Readiness: DOH has submitted a state-directed preprint that will allocate $180.47 million SFE ($360 million total) to a subset of licensed home care services agencies (LHCSAs). DOH is currently awaiting approval of the preprint. However, it has not yet allocated the remaining $626.61 million SFE proposed for this project. It intends to decide based on the success of the initial program whether to allocate further funds to LHCSAs or to expand funding for other provider types.
- Support Program Growth in Personal Care Services and Consumer Directed Personal Assistance Program (CDPAP): Due to CMS objections, DOH has retracted this proposal, which would have used $415 million SFE to support the expenses associated with projected growth in utilization and cost of personal care services.
- Improve the OPWDD Workforce: The Appendix K authority to implement this proposal was approved in November 2021, and OPWDD expects to distribute payments and launch grants shortly.
The Update also includes nine new projects for which it is seeking CMS approval, which fall into the existing three categories:
- Workforce
- Homecare Worker Bonus ($418 million SFE; $836 million total)
- Improve and Support the Assisted Living Program (ALP) Workforce ($20 million SFE; $40 million total)
- HCBS Capacity and Innovation
- Incentivize Child Welfare Step-Down Programs ($2.2 million SFE; $4.4 million total)
- Evidence Based Children’s Services ($4.7 million SFE; $9.4 million total)
- New Children’s Waiver HCBS Services ($2.5 million SFE; $5 million total)
- School Supportive Health Services Expansion ($5.7 million SFE; $11.4 million total)
- Invest in Outpatient Mental Health Rehabilitative Services ($31.8 million SFE; $64.6 million total)
- Expansion of the Community Care Connections Program ($2.8 million SFE, no additional match)
- Digital Infrastructure
- Strengthen the NYS Multiple Systems Navigator ($14.8 million SFE; $29.1 million total)
The full Quarterly Update is available here. Attached is an updated version of SPG’s summary table outlining all of the proposed HCBS enhancement projects and their current status. The table can also be found here.