This issue of the Schuyler Center Source

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1 Schuyler Center Source policy analysis advocacy Welcome to Issue #10 of the Schuyler Center Source, a newsletter devoted to public policy issues of importance to New York State s children, families and communities. Visit the SCAA website homepage at to access: A new SCAA issue brief, The Importance of Fatherhood in Home Visiting SCAA Testimony and schedule for joint legislative public budget hearings Click on the Children s Policy Agenda page link to access this issue in a pdf and see Quick Links from the online version. January STATE STREET, 4TH FL. ALBANY, NY TEL FAX New York State Executive Budget Innovation and Stagnation This issue of the Schuyler Center Source is primarily focused on the State Fiscal Year Budget and specifically, the Executive Budget proposal released on Tuesday, January 17, Now that the Governor has released his budget proposal, over the next several weeks Senate and Assembly Committees will hold hearings by topic area, to receive input from State Agency leadership, advocates, service providers, localities, and the public about their perspectives on the State Budget. The budget hearings present an opportunity for Legislators to question the Administration s proposals and to make their own positions known. They provide advocates with the chance to identify areas of concern and potential implications and to reinforce good ideas. On the health front, the Governor included the creation of a health insurance Exchange in this year s proposed budget legislation. The legislation is similar to the final three-way (Senate, Assembly and Governor all agreed on it) language from last June that ultimately did not get voted on before session ended. New York State needs this legislation in order to move forward in developing a health insurance marketplace that makes health coverage more affordable for businesses and everyday people and that is ready to enroll people by January A further delay in passing Exchange legislation would mean minimal time for thoughtful planning, community engagement, and infrastructure development. Significantly, the Governor also moves forward with the recommendation of the Medicaid Redesign Streamlining and State/Local Responsibilities Workgroup that the State should develop and implement a plan for Medicaid financing that reduces reliance on local property taxes. The Governor s budget focuses on innovation and accountability and there are several new initiatives that aim to improve the lives of lowincome and vulnerable children and families. Additional funding for food stamps (also known as SNAP) outreach aims to ensure that more eligible people are able to get food assistance; the additional state dollars will be matched with federal dollars to do so. Governor Cuomo also promised in his State of the State message to end New York City s fingerprinting of food stamp applicants in an effort to eliminate barriers for families to obtain food stamps. A provision addressing language access for prescription medications will require that chain and mail order pharmacies provide translation and interpretation services for limited English proficient (LEP) patients. And a new $2 million in the child welfare arena will go toward incentivizing innovative public-private endeavors focused on early childhood development and services to at-risk families. In juvenile justice, the Governor proposes a stepped approach to bring children and youth who are originally from New York City closer to home, into New York City administered programs, services and care beginning this fall. Funding for the proposal incentivizes community-based services over residential care, a strategy that is likely to achieve better outcomes. New York s extremely low-income children and families remain stuck. The number and percentage of people and children living in poverty increased again between 2009 and 2010; more than one in five New York children live in families with income below the federal poverty level. The Governor proposes again delaying the legislated increase in the TANF (welfare) grant for very low-income families. For low-income workers, there is nothing in the Governor s budget that addresses increasing the minimum wage or improving the earned-income tax credit.

2 The Governor s budget proposes $250 million for a performance grant system for schools that appears likely to penalize schools in low-income communities that are ill-equipped to compete. The Commissioner of Education, John King, is concerned that some districts risk programmatic insolvency, and will be unable to offer a full slate of classes to prepare students for college or the workplace. The Governor s budget does include $93 million to make up for lost federal funding for child care subsidies for low-income working families, but demand continues to outstrip supply and there is no investment in ensuring the quality of child care/early learning and development programs specifically, QUALITYstarsNY. This is despite considerable evidence that, for children in low-income families, early investments in programs such as high-quality early learning can have significant and lasting benefits. There are several new proposals that SCAA expects to delve into more deeply and analyze over the coming weeks. These include a proposal to redesign Early Intervention and another to make changes to preschool special education. Overview of Selected Executive Budget Proposals Child Welfare Child Welfare Financing Law. The Child Welfare Financing Law is due to expire in June The Executive Budget proposes extending the law until 2017 with the following changes: Establishing in statute the current funding rate of 62% state share for preventive, protective, adoption, independent living, and after care services and 62% for adoption subsidies. Current law provides 65% for preventive and 75% adoption subsidies. Over the past three years the budget language amended the language in statute to reduce the state share: for example, 94% of 65%. The proposal changes that language for the next 5 years. Adds Kinship Guardianship Assistance (KinGap) under the Foster Care Block Grant. Specific Child Welfare budget items. Preventive funding remains open-ended (not capped), with a 62% state share. Over the past two years, preventive service claims have decreased 14%. The decrease in claims comes at the same time the state share for these services decreased from 65% to 62% (94% of 65%). Community Prevention Services (COPS) is funded at the level of $12,124,750. This is a significant (79%) reduction from the COPS of $55 million in the budget. COPS provides important flexible funding for primary prevention programs such as home visiting, co-location of services and services for cross-systems children whose needs are not easily met through other funding streams. KinGAP is funded through the Foster Care Block Grant with no dedicated funding for this new permanency option. The Foster Care Block Grant is already fully utilized to meet the needs of children placed into foster care. All localities exceed their allocation yearly and use local dollars to meet the needs of children in placement. Foster Care Block Grant is maintained at $436,002,000. Additional proposals: Eliminates funding for Settlement Houses. The Children and Family Trust is flat funded at $621,850. Funding for caseload reductions was eliminated. Increases Medicaid funding for foster care children by $2,350,000. Increases funding for Committee on Special Education placements by $678,000. Funding for other child welfare items is maintained at levels in the Budget. Human Services Regional Public Private Partnership Pilot Programs. The Executive Budget proposes a public private partnership with $2 million in new funding. The purpose of the pilot is to leverage private dollars for new and innovative programs as well as for expansion of high quality preventive, early childhood development and other services to at-risk children, youth and families. The State will provide a maximum of 65% share of the costs to be matched with 35% in private dollars. Funding will be allocated through a competitive process. 2 Schuyler Center Source

3 Vulnerable Persons Central Register. The Executive Budget proposes the creation of a new 24 hour reporting system for abuse and neglect allegations of children, the developmentally disabled, Office of Alcoholism and Substance Abuse, OCFS, DOH, and SED. There are no details at this time. The impetus for this new hotline is a preliminary recommendation from the Governor s Special Advisor on Vulnerable Persons, Clarence Sundram. Funding for the reporting center will be included in the OCFS budget: $10 million for and $30 million for Public Assistance Grant increase. The expected Public Assistance grant increase of 10% would be spread over two years with a 5% increment for and another 5% for The 10% increase was already postponed for one year. Human Services Cost of Living Adjustments. The Executive Budget eliminates the planned 3.6% increase for OCFS programs including foster care, adoption, Bridges to Health, and New York/New York III. The COLAs were postponed in the past few years. Next year, a new program will be established linking increases to provider costs and performance outcomes. Juvenile Justice reforms. The Executive Budget continues the reforms already underway in juvenile justice by closing facilities and reducing capacity by 324 beds and allowing all New York City youth who are in non-secure or community-based settings to be placed in New York City-administered programs in the fiscal year. The proposal for this Close to Home initiative provides funding for a portion of the year of $8,614,000 in the Budget. Implementation begins in the fall with the transfer of non-secure youth. Those in limited-secure facilities will transfer in April Early Learning & Development Child Care Subsidies. The Executive Budget increases General Fund support for child care subsidies by $93 million to offset a reduction in funding through the federal TANF monies. The $93 million puts funding back at the level. A large number of counties continue to have waiting lists for subsidized child care. Infant/Toddler Resource Centers. The Executive Budget funded the Centers at $1.1 million. In , federal stimulus funds were used to expand the Centers, increasing the appropriation to $2.2 million. Those funds are no longer available. Pre-K/Kindergarten. The Executive Budget maintains the appropriation for Pre-K of $384 million. The Governor has proposed a 4% increase in school aid for K-12. Districts will not receive any of the new funding unless they have fully implemented their teacher evaluation system within one year (January 17, 2013). Notably, the Regents propose an additional $53 million for Pre-K. Preschool Special Education. The Executive Budget proposes shifting some of the program costs from the state level to local school districts. The intent, as described by the Division of Budget, is to make districts take a more pragmatic view of spending. Home Visiting. The Executive Budget maintained funding for Healthy Families New York at $23 million. It also maintained $12.1 million in Community Optional Preventive Services (COPS) funding. COPS helps fund Nurse-Family Partnership programs. In addition, the Budget maintained over $600,000 in funding for the Children and Families Trust Fund, which partially supports The Parent-Child Home Program. Early Intervention. Early Intervention (EI) provides evaluations and services to infants and toddlers with developmental delays or disabilities and their families. The Executive Budget proposes a significant restructuring of the EI program. The proposal would make a health insurance representative part of the team that develops and reviews the child s EI services plan, would require EI providers to join health insurance networks and negotiate their rates with health insurance companies, and would require that evaluations and services be performed by providers in the child s health insurance network unless certain exceptions apply. The budget anticipates a $99 million savings over five years. Afterschool. The Executive Budget funded Advantage Afterschool programs at $17.5 million, a reduction from the funding of $22.5 million. Adult Homes Adult Home Housing and Funding. The Executive Budget allocates 5,100 supported housing units for adult home residents and individuals discharged from psychiatric facilities over the next three years. Of those, 2,100 would be in place by the end of There would also be 3,400 additional beds from the NY/NY III Agreement, 800 of which would place by the end of There is also $16.8 million in the Executive Budget for Schuyler Center Source 3

4 education, assessments, training, in-reach, care coordination, supported housing and the services needed by mentally ill residents of adult homes which were identified in the 2009 federal district court case Disability Advocates, Inc. v. Paterson. There remains a stay in the court order in that case. Health Phased Takeover of Medicaid Local Administration and Cap on Local Expenditures. The Governor moves forward with the Medicaid Redesign Team (MRT) recommendation that the State should develop and implement a plan for Medicaid financing that reduces reliance on local property taxes. Legislation passed several years ago capped the growth of county costs and subsequent legislation called for a state takeover of the administration of the program. The Executive Budget would transfer to the State Department of Health certain activities, such as the processing of Medicaid applications, making eligibility determinations and authorizing benefits. The Governor s budget also proposes to further reduce the current 3% annual cap on increases in the local share of Medicaid. The Executive estimates a five year savings of $1.2 billion for counties and New York City. In 2013 the current 3% local expenditure growth cap will be reduced to 2%. In 2014 the 2% local expenditure growth will be reduced to 1%. In 2015 the 1% local expenditure will be reduced to zero. Beginning in calendar year 2015, the local share for Medicaid will be capped and no longer grow. Primary Care Service Loan Repayment Program. The Executive Budget proposes creation of a new loan repayment program for non-physician practitioners who agree to practice full-time in an underserved area of the state. If enacted, eligible practitioners would be: physician assistants, nurse practitioners, nurse midwives, general or pedodontic dentists, dental hygienists, clinical psychologists licensed clinical social workers, psychiatric nurse practitioners, licensed marriage and family therapists or licensed mental health counselors who provide coordinated primary care services. $1 million is proposed in the Executive Budget. Supportive Housing Development Reinvestment Program. The Medicaid Redesign process identified adequate housing as a necessary component for maintaining health in vulnerable populations. In addition, the Governor has made a major commitment in his State of the State address to advance a NYS Olmstead plan that will move people and funds from segregated to most integrated residential and employment settings. The Executive Budget would establish a Supported Housing Reinvestment program that would redirect savings from decreased inpatient and nursing home stays; develop adequate and accessible housing to support vulnerable persons in the community; and ensure they have access to supports necessary to maximize outcomes. Included are commitments over the next three years to move 1,000 nursing home residents and 5,100 adult home and state PC residents into community housing and to create 3,400 NYNY III beds. This year s budget includes $10 million for supported housing for nursing home residents and $16.8 million for such housing for adult home residents. New York Health Benefit Exchange. The Executive Budget proposal contains language that would establish a public benefit corporation to serve as the Health Benefit Exchange for New York State in accordance with the Affordable Care Act (federal health care reform law). The Exchange would allow individuals and small groups to purchase qualified health plans, receive eligibility and subsidy determinations and be enrolled in a range of coverage options, including public health coverage programs. The Executive Budget includes language that would: Establish the Exchange with a Board of Directors consisting of nine members. Establish five Regional Advisory Committees. Provide for certification of health plans by January 1, Outline consumer assistance provisions. Establish the Small Business Health Options Program to assist small employers in enrolling their employees. Provide for the study of outstanding decisions that need to be made regarding the framework for the Exchange. Nutrition Outreach and Education Program (NOEP). To expand access to the federal food stamp program, the Executive Budget proposes an additional $1 million to the Nutrition Outreach and Education Program (NOEP). NOEP conducts food stamp outreach, education and application assistance in underserved areas of the state. The state money would be matched by $1 million in federal money. 4 Schuyler Center Source

5 Office for People with Developmental Disabilities (OPWDD). The Executive Budget would reorganize OPWDD into Regional Offices and State Operations Offices to oversee service delivery around the state. The State Operations Offices would administer delivery of support and services in State operated programs. Regional Offices would oversee the administration of supports and services in settings outside of State programs. The intent is to streamline decision-making and better align responsibilities to serve individuals with disabilities. The proposal would also allow the Department of Health, the Office of Mental Health, the Office of Alcoholism and Substance Abuse Services and OPWDD to more fully integrate health and behavioral health services. This would include the ability to waive regulatory requirements or determine that compliance with another agency s requirements is sufficient in order to avoid duplication. Language Access for Prescription Drugs. A provision in the Executive Budget would require pharmacies to provide free, competent oral and written interpretation services to limited English proficient individuals filling a prescription. The services would need to be available for the seven most prevalent languages in New York State and be provided in the individual s primary language for the purpose of counseling about the medications, interpreting label information or when soliciting information to maintain a patient medication profile. Additional Medicaid Redesign Proposals. The Executive Budget contains provisions for implementing a number of proposals that were proposed by the MRT. The budget language will allow for their implementation after they have been approved in by a federal waiver. These include: coverage for podiatry for persons with diabetes, lactation counseling, harm reduction counseling to reduce or minimize the consequences of drug use, and hepatitis C wrap-around services. Though not mentioned in the Budget documents, it is expected that the MRT recommendation regarding support for the Nurse-Family Partnership s maternal, infant and early childhood program for at-risk families would also be included in the forthcoming waiver application. The Executive Budget also would authorize the Commissioner of Health to contract with one or more entities to engage in education, outreach and enrollment assistance for aged, blind and disabled Medicaid applicants, a recommendation of the Streamlining Workgroup. About Us The Schuyler Center for Analysis and Advocacy (SCAA) is a statewide, nonprofit, policy analysis and advocacy organization working to shape policies to improve health, welfare and human services for all New Yorkers, especially those who are poor or vulnerable. Visit our website at and sign up to receive the electronic version of this newsletter. Schuyler Center Source 5