New York s New Budget: More Pain Than Gain for Health and Human Services When the Executive Budget was released on February 1, 2011, it promised pain in a lot of areas. Services to children and families were particularly hard hit as were economic security for lowincome people and some health and mental health programs. The ambitious and sometimes controversial recommendations of the Medicaid Redesign Team were wrapped into the Executive Budget late in the game, making analysis of layered implications for vulnerable populations difficult. While there were a few significant restorations in the final budget, there were also many deep cuts. To see the final budget documents, visit the Senate and Assembly websites. Child and Family Services The Executive Budget s proposal to create a Primary Prevention Incentive Program (PPIP) was rejected, but funding was reduced by 50% for many programs that localities use to help atrisk children and youth. (See chart) Program 2010-11 Budget Final Budget Healthy Families New York $23,288,200 $23,288,200 Hoyt Trust Fund $ 1,243,700 $621,850 Kinship Contract $ 677,500 $388,750 COPS $24,249,500 $12,124,000 Youth Development and Delinquency Prevention Program (YDDP) Special Youth Delinquency Prevention Program (SDPP) $21,245,350 $10,622,675 $ 6,998,050 $3,499,025 Runaway Homeless Youth $ 4,711,600 $2,355,800 Caseworker Caseload Ratio $ 1,514,000 $757,200 Settlement Houses $ 900,000 $450,000 Total Funding $84,827,900 $54,108,250 State Central Register Clearance Fees were increased from $5 to $25 and child care providers are no longer exempt. This change takes effect on April 8 th. Fees will be collected in multiple venues. This is now a fee for child care workers who are often low-income.
Funding for the Healthy Families New York (HFNY) home visiting program was fully restored ($23M). Funding for COPS, which partially funds the Nurse-Family Partnership (NFP) program and funding for the Hoyt Family Trust Fund, which partially funds The Parent-Child Home Program (PCHP), were decreased. Additional money for NFP that was funded through TANF was not restored ($2 million). With full funding for HFNY, it appears that the state may go forward with its application for federal home visiting funding. This funding will help to expand and improve home visiting services. Implications of the reductions to NFP and PCHP are as yet unclear. Localities will pay an increased share for adoption subsidies, as the state share is reduced from 73.5% to 62%. The state share for Committee on Special Education (CSE) placements was reduced from 36.8% to 18.424%. Over 95% of all adoptions are eligible for subsidies. Decisions regarding CSE placements are made by local school districts with funding coming from local departments of social services budgets. The formula change places an increased burden on local budgets. Funding for the Advantage After School Program (AASP) was maintained at $17.2 M (General Fund) and $500,000 in TANF funds were restored. The total FY12 allocation of $17.7 M represents a decrease of $4.8 M in overall funding for AASP compared to the FY11 funding level of $22.5 M. Research on afterschool programs has shown that they are cost-effective. Every dollar invested in high-quality afterschool programs saves taxpayers roughly $3, according to a study by the Rose Institute at Claremont McKenna College. Factoring in benefits from crime reduction raises that savings to $8-$12 for every dollar invested in an at-risk child. Funding for child care subsidies was maintained but the loss of $5 M in federal stimulus funding will result in an estimated 6,000 lost slots. SUNY/CUNY funding was reduced to $1,634,000 and funding for Child Care Demonstration Projects was reduced to $3,395,000. SUNY/CUNY child care helps to ensure child care for low-income students enrolled in a twoyear college program. The Child Care Demonstration projects provide much-needed subsidies to working families. The previously approved increase in the public assistance grant will be delayed by one year, to 2012. The state share for the Safety Net program was reduced from 50% to 29%, leaving localities a 71% share of costs. The promise of a 30% increase is maintained in the 2011-12 Budget, but the last installment of a 10% increase is delayed for another year. Kinship Guardianship Assistance will be funded through the Foster Care Block grant for one year. Implementation of the Kinship Guardianship Assistance Program began April 1, 2011. The enacted budget allows localities to use the Foster Care Block Grant to fund Kinship Guardianship Assistance for the current budget year. The Foster Care Block Grant is already fully utilized in meeting the needs of foster care children.
Some restorations were made to TANF funded programs. Funding for these programs has decreased considerably over the last two years. (See chart) TANF PROGRAMS 2009 10 2010-11 2011-12 ACCESS Welfare to Careers $ 500,000 $ 250,000 $ 250,000 Advantage Schools $ 11,391,000 $11,213,000 $ 500,000* Alternatives to Detention/Residential Placement $ 10,752,000 $ 6,000,000 0** ATTAIN Technology training $ 7,000,000 0 0 Bridge $ 8,503,000 $ 1,000,000 $ 102,000 Build NY 0 0 0 Career Pathways $ 10,000,000 $ 5,000,000 0 Caretaker Relative $ 1,998,000 $ 250,000 $ 51,000 Centro of Oneida $ 125,000 0 $ 25,000 Child Care SUNY/CUNY $ 3,400,000 $ 1,644,000 $ 334,000*** Child Care Demonstration Projects $ 10,900,000 $ 5,265,000 $ 3,395,000 Community Solutions to Transportation $ 2,200,000 0 $ 112,000 Disability/Advocacy Program (DAP) $ 1,000,000 $ 483,000 $ 98,000 Displaced Homemakers $ 5,600,000 $ 1,605,000 $ 546,000 Educational Resources $ 3,000,000 $ 125,000 0 Emergency Needs for the Homeless $ 2,000,000 $ 125,000 $ 176,000 Green Jobs Corps Program $ 5,000,000 $ 2,000,000 0 Health Care Jobs $ 5,000,000 $ 2,000,000 0 Home visiting $ 5,822,000 Moved to General Fund 0 Intensive Case Services $ 3,000,000 0 0 LIVES: VESID employment services $ 1,500,000 0 0 Non-residential Domestic Violence $ 3,000,000 $ 1,449,000 $ 510,000 Nurse-Family Partnership $ 5,000,000 $ 2,000,000 0 Preventive Services $ 18,792,000 $ 6,000,000 $ 610,000 Refugee Resettlement $ 1,425,000 $ 500,000 $ 102,000 Rochester-Genesee Regional Transportation Authority $ 2,000,000 $ 403,000 $ 82,000 Settlement House $ 6,000,000 $ 1,000,000 $ 500,000 Strengthening Families through Stronger Fathers $ 2,764,000 0 $ 200,000 Summer Youth Employment $ 35,000,000 $ 15,500,000 $15,500,000 SHIP: Supplemental homelessness $ 5,000,000 $ 1,006,000 $ 205,000 intervention program Supportive Housing for Families $ 5,000,000 $ 2,500,000 $ 508,000 Transitional Jobs $ 5,000,000 $ 5,000,000 0 Wage Subsidy $ 14,000,000 0 $ 950,000 Wheels for Work $ 7,000,000 $ 409,000 $ 144,000 Subtotal: $208,672,000 $72,727,000 $24,900,000 FFFS fund $964,600,000 $960,000,000 $951,000,000 Child Care Subsidies $392,967,000 $392,900,000 $392,967,000 Subtotal: $1,357,567,000 $1,352,900,000 $1,343,967,000 TOTAL: $1,566,239,000 $1,425,627,000 $1,368,867,000 *The Executive Budget proposed a $5 M increase in the general fund budget for Afterschool programs and eliminated $11.2 M in TANF funding. The final budget accepted the increase in the general fund and increased TANF funding from $0 to $500,000, representing an overall decrease in funding of $4.89 M. **Alternatives to residential placement programs were replaced by the Supervision and Treatment Services program in the general fund. *** Additional funding included in the Higher Education Budget.
The budget provides $76.3 million in capped funding for secure and non-secure detention at 49% state share or for alternatives to placement at 62% state share. A new Supervision and Treatment program is funded at $8.2 million with no local share required. A 60-day notification for closure of facilities is required for the budget year with criteria that must be considered before each closure. In addition, the Persons in Need of Supervision (PINS) population is eligible for services funded by the Supervision and Treatment program and for foster care or detention placement when needed. The changes in juvenile justice funding aim to shift practice toward community-based treatment and services and reduce capacity by 376 beds or 31%. Additional funds are also provided to improve OCFS facilities for those who must be placed, continuing the reforms required by the U.S. Department of Justice. Health, Including Mental Health $20 million is invested in supported housing and support services for psychiatrically disabled individuals leaving New York City adult homes. It is anticipated that this amount will be sufficient to proceed with the development of housing this year. This fund is part of a multi-year plan to provide funding for additional supported housing and support services for psychiatrically disabled individuals to leave New York City adult homes. The Center for Health Workforce Studies (CHWS) was funded at $196,000. The CHWS is the state-funded entity that engages in health workforce analysis. This is a reduction from last year s funding of $392,000. The Executive Budget eliminated funding for CHWS. This loss would have drastically reduced the state s ability to understand a critical component of health care at the same time significant system changes are underway. The proposal for increases to co-payment amounts for Medicaid Fee-for-Service and Family Health Plus, and to implement copayments for Child Health Plus was rejected. Public health insurance programs are designed to serve low-income and vulnerable populations and must remain affordable. Research suggests that cost sharing may inhibit enrollees from seeking necessary and cost-effective preventive and other care. Two across-the-board reductions in Medicaid are contained in the budget. The first is a uniform across the board reduction in Medicaid equal to 2% of Medicaid payments. Facilities licensed by The Office of Mental Health, the Office of Persons with Developmental Disabilities and office of Alcoholism and Substance Abuse Services are exempt. The second is a Medicaid Global Cap limiting Medicaid spending growth to medical CPI. Advocates remain concerned that a hard cap on Medicaid expenditures as across the board reductions will hurt vulnerable safety net providers, programs, and communities the hardest.
The budget begins the process of expanding managed care enrollment to all populations over three years. This includes very vulnerable populations such as disabled children and children in foster care. Enrollment in managed care does not guarantee improved coordination of care and can, in fact, bring numerous and significant new problems. Extreme care and consideration must go into every detail of this proposal and an essential component must be active consumer engagement in planning, implementation and ongoing monitoring. The budget authorizes the state to implement utilization controls on behavioral health. SCAA continues to believe that the state should not pursue short-term savings through fewer visits at the risk of long-term poor health outcomes and higher costs to individuals, communities and the Medicaid system. Reimbursement to county health department for services in the optional category of Article VI was eliminated. These services include dental clinics, emergency medical services, laboratory services and home health care. These cuts will make it more difficult for county health departments to prevent and address health needs in their communities. Rates paid to providers for Early Intervention (EI) services were reduced 5% instead of the proposed 10%. EI reduces special education costs, increases parent involvement, and produces significantly better outcomes in teenage and adult health, behavior, and productivity. Higher Education The budget maintained last year s reduction in the maximum TAP allowance for students in two-year degree programs from $5,000 to $4,000. The continued reduction in the maximum TAP allowance for students in two-year degree programs from $5,000 to $4,000 represents a significant decrease for students and will likely have a negative impact on those low-income students who most need assistance to attend and/or remain in college.