The above picture is from Governor Andrew Cuomo’s budget address today. He is citing a Daily News Editorial from yesterday, which said, in part, “The Medicaid-funded personal care industry added 36,000 new jobs in the first nine months of 2019, making up 75% of citywide private-sector hob growth over that period.”
Typically, this would be a positive. What politician doesn’t like new jobs, particularly if he or she could possibly take credit for them? After all, it was Governor Cuomo’s first MRT, combined with his signing of a new law that opened up CDPA to parents of children over the age of 21, that led to the enormous growth in the program after two decades of stagnancy. In this budget, he crowed about the fact that his Regional Economic Development Councils (REDCs) have handed out $6.9 Billion over the past nine years to create 240,000 new jobs. Indeed, he was willing to give one company, Amazon, owned by the wealthiest man in the world, $3 Billion to create just 25,000 new jobs in New York City last year.
But somehow, these jobs are different. These jobs are dirty. These jobs are, in the Governor’s words, “unsustainable.”
Why? What is it about these jobs that are different?
That is the question we will be asking the Governor and the Legislature over the next few months. Because, as you may have guessed, today’s budget means that we are in for at least two more months of our fight to #SaveCDPA.
The Governor in essence declared Medicaid broken today. And he blamed CDPA.
But don’t take my word for it. From his briefing book, “[Managed Long Term Care] spending growth overall – and CDPAP within it – have been the biggest drivers of spending growth in New York’s Medicaid program.”
He went on to note that, “Between 2017 and 2018 alone, spending for CDPAP grew by 85 percent from $1.5 billion to $2.4 billion.”
I read this as we got 1.5 times the number of jobs Amazon promised for a third the cost (the $900,000 difference between spending between the two years). Unfortunately, Governor Cuomo sees this as a program out of control.
He is blaming New York City. He is blaming Fiscal Intermediaries. He is blaming you.
He is not recognizing that if everyone of these people in CDPA had to get services from traditional home care, the cost would be 1.5 times or more the cost of CDPA. He is not recognizing that these services would cost double or triple in a nursing home.
No, he is mad jobs are being created to take care of people in the community, at their direction.
Enter the next phase of the Medicaid Redesign Team, MRT II (he went with roman numerals, personally, I would have gone with MRT 2.0, but that’s me…) to cut $2.5 Billion
In his MRT II, he specifically states that the cuts shall be uniform across all categories and geography, unless there are “sufficient grounds” for non-uniformity, such as the extent to which a specific category has contributed to the excess spending. While this may on its face seem fair, shouldn’t we more focus on what services we want to prioritize? Wouldn’t it be better to see the extent to which we could shut down nursing homes, move people into the community, and provide these services for less money and greater personal freedom, in compliance with the Americans with Disabilities Act?
I think so. But, nursing home jobs are apparently better jobs than CDPA jobs. Nursing home jobs are a critical part of the economy.
To Governor Cuomo, CDPA jobs are “excess.”
Will you tell him they aren’t?