NYAPRS Note: There’s been a good deal of recent media coverage about how Governor Cuomo’s resolve to see New York develop a strong Olmstead Plan will result in the downsizing and closure of state institutions that serve people with disabilities. The following editorial underscores this point, as did YNN coverage of a discussion Liz Benjamin and I had yesterday at http://capitalregion.ynn.com/content/capital_tonight/video/620905/harvey-rosenthal-interview/.
Editorial: N.Y. Has Reasons To Rethink Care
Poughkeepsie Journal Editorial December 11, 2012
When it comes to providing the best care for those with developmental disabilities and dealing with the cost of its skyrocketing Medicaid program, the state has a ton of work to do.
Surely, New York officials have known this for years, if not decades. But, soon, it is going to get a major financial incentive to deal with these issues on a more comprehensive and faster level.
Gov. Andrew Cuomo has publicly supported and pushed for changes, including having the state shift the care of those with developmental disabilities from massive and ineffective institutions to community-based settings. The state, in fact, started that process decades ago and was making good headway. But then progress stopped.
The Poughkeepsie Journal conducted an investigation that unearthed plausible explanations for the snag - the state has been using these huge facilities as a cash cow of sorts, receiving an incredibly inflated Medicaid rate from the federal government for patients who are kept in such facilities.
The Journal’s investigative series “Money Pit/Money Maker” found that the state Medicaid reimbursement rate has risen to $5,118 per resident per day - more than four times higher than any other rate nationwide.
In short, the state has been overbilling the federal government and using the extra money for other services. This egregious, indefensible practice undermines the notion that decisions should be based solely on what’s best for the patients. Usually, that means placing them in the least restrictive environment possible.
Last week, Cuomo issued an executive order creating a Cabinet charged with designing a plan that halts those with disabilities from being unjustifiably segregated from the general population. The governor already is on record as supporting the closure of more of these giant facilities, including the Wassaic campus of the Taconic Developmental Disabilities Service Office.
Clearly, the state’s decades-old efforts of delaying this movement are numbered.
The federal government now deems the state’s reimbursements rate “excessive and inappropriate” and plans to make changes. Medicaid is a critically important but bloated program, one that faces an tenuous future in light of the federal government’s mounting debt.
The governor’s executive order says the state “is committed to the principle that people with disabilities should have access to community-based services, accessible housing with appropriate supports, and employment opportunities that enable them to live productive lives in their communities.”
These are lofty, important goals, and the governor’s Cabinet has until the end of May to submit a final report to lay out the plan. The state should have felt compelled to do this long ago. Facing a financial hit, it has all the more reason to expedite a process that got bogged down in the worst of bureaucracy and government entrenchment.