On May 25th, the New York State Department of Health (DOH) posted the Third 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 $2.56 billion in state funds equivalent (SFE), up by an additional $122 million from the second 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 $5.2 billion (up from $4.8 billion in the last update) will be available for investments to improve HCBS.
The Third Quarterly Update also contains new information on the current status of proposals. DOH has withdrawn and replaced one proposal, but the other 46 proposals remain the same as in the second quarterly update. Of the proposals, 37 have been approved by CMS, the same as before. NYS is awaiting approval on one original proposal, the eight proposals from the Second Quarterly Update, and the new proposal in this update. NYS has begun spending for 14 of the 37 approved projects. Notable changes to proposals include:
- Home Care Worker Wage Increase: This is a new proposal that replaces the “Home Care Worker Bonus” proposal. It would implement the 2023 Enacted Budget provision that increases the minimum wage for home care workers (home health aides, personal care aides, home attendants, and consumer-directed personal assistants) by $3 per hour. This would use $1.22 billion in SFE, nearly half of the total. As of the time of the update, DOH was still considering how to obtain federal authority.
- Transform the Long-Term Care Workforce and Achieve Value-Based Payment Readiness: This project has been decreased in scope to include only the already-approved state-directed payment that will provide $143 million of SFE ($358 million total) to licensed home care services agencies (LHCSAs) in the top third of providers in utilization. The remaining $620 million that was originally allocated has been moved to pay for the Home Care Worker Wage Increase.
- Enhanced the Children’s Services Workforce: Health Homes Serving Children have been removed from the eligible providers for funding through this proposal.
- Expand Capacity in the NHTD and TBI Waivers: LHCSAs have been removed from the eligible providers for funding through this proposal.
- Evidence-Based Children’s Services: HCBS providers have been removed from the eligible providers, leaving only CFTSS providers. This proposal has not yet been approved as it was added in the previous quarterly update.
The full Quarterly Update is available here. An updated version of SPG’s summary table outlining all of the proposed HCBS enhancement projects and their current status is attached here.