Governor Cuomo unveiled his $193.3 billion 2021-22 Executive Budget today. With a looming $15 billion deficit, the Governor's message reflected the difficulties caused by the COVID-19 pandemic and fiscal challenges in FY 2022 and beyond.
Despite better-than-expected revenue, the state faces losses of $11.5 billion in FY 2021 and $9.8 billion in FY 2022. The Governor continued his call for the federal government to repeal the federal deduction cap on State and Local Tax (SALT) and for $15 billion in direct state and local aid from the pool of $350 billion proposed in President-Elect Biden's $1.9 trillion "American Rescue Plan."
The budget as written includes an unguaranteed $6 billion in funding from the federal government, and contains separate appropriations in the event the requested $15 billion is received. It also leverages the remaining $2.5 billion from the Coronavirus Relief Fund (CRF) and approximately $500 million from increased Medicaid matching funds.
With employment not expected to recover to pre-pandemic levels until 2023, a projected $39 billion budget shortfall and $21 billion revenue loss over the next two years, the state faces an unprecedented crisis. This budget relies heavily on the hope of federal aid, and we anticipate strong federal advocacy will be needed in the months ahead.
Specific to the I/DD field, the executive budget broadly states support for new service opportunities, including expanding independent living, day program and employment options and respite availability, and promoting choice in service options such as self-direction. No additional information was provided regarding the transition to managed care, only that the state continues to assess the effectiveness and sustainability of the proposed delivery system for the Office for People With Developmental Disabilities (OPWDD).
While by no means exhaustive, we hope the information below assists Chapters in understanding what is ahead for this fiscal year and beyond. We will continue to update you once budget bills are released and further budget discussions are held.
Budget References
Highlights of the 2021-22 NYS Budget
The proposed 2021-22 Executive Budget:
- includes an overall investment in OPWDD of $107.6 million, representing a 2.8% increase over FY2021.
- defers FY 2022 Human Service COLA payment.
- commits an additional $15 million to develop housing. These funds are distinct from, and in addition to, resources available from the five-year, $20 billion affordable and supportive housing plan.
- reduces local assistance payments. OPWDD non-Medicaid local assistance payments will be reduced by 5% effective 4/1/21. This alters the previous 20% withhold to 5%, but the amount of reimbursement for the prior months of withholding remains unclear. These spending reductions may be restored if the State receives requested federal COVID-relief funds.
- leverages an additional $38.5 million in state funds to support minimum wage increases for staff at not-for-profits licensed, certified, or otherwise authorized by OPWDD, OMH, and OASAS.
- implements a temporary surcharge on the wealthiest New Yorkers to raise $1.5 billion.
- freezes the implementation of middle-class tax cuts to save $400 million.
- adds new revenue sources in adult-use cannabis and mobile sport wagering anticipated to raise $850 million annually when fully implemented.
Further Actions
Manage Access to Residential Programs Based on Need
OPWDD will actively manage residential programs to ensure that individuals live in settings that most appropriately align with their needs. Specifically, the Budget proposes to help individuals living in State-operated residences transition to voluntary-operated programs where appropriate, to accommodate young adults with more intensive needs that have aged out of residential schools. This concept has been presented and championed by The Arc New York directly to OPWDD for some time.
Create the New Office of Addiction and Mental Health Services
In a continuation of previous efforts to coordinate and align services for individuals with addiction and mental illness, the Executive Budget integrates the Office of Addiction Services and Supports and the Office of Mental Health to create a new agency: the Office of Addiction and Mental Health Services.
Medicaid Redesign Team 1115 Waiver Extension
The Department of Health is preparing to file a three-year extension to the existing MRT 1115 Waiver by March 2021. Once the MRT Waiver is extended, additional funding requests can be pursued. New York will explore new initiatives through amendments to the approved waiver on Medicaid policy priorities, including telehealth, alternative payment methodologies, workforce and Health Equity, Social Determinants of Health, and addressing the COVID-19 pandemic impact on the State's health care delivery system.
Telehealth Reforms
COVID-19 has changed how we approach and deliver services. The following is a broad overview of proposed modifications included in the Executive Budget.
- Increasing access to services through comprehensive reform with changes to a variety of methods, including continuing telephonic delivery of care and establishing interstate licensure, allowing certain unlicensed staff (e.g. Credentialed Alcoholism and Substance Abuse Counselor trainees) to deliver substance use disorder services, expanding covered telehealth providers, eliminating obsolete location requirements, expanding reimbursement for patient monitoring, integrating telehealth into New York's state-of-the-art health information network, the Statewide Health Information Network for New York (SHIN-NY), requiring telehealth in commercial insurance, and expanding access to mental health and addiction services.
- Promoting innovative technologies and approaches by increasing training and education opportunities, establishing a pilot program to facilitate telehealth for vulnerable populations, requiring insurers to offer e-Triage and Virtual Emergency Department, and allowing insurers to satisfy contractual care management requirements by utilizing emerging telehealth solutions that enhance care management efforts and integrated multi-disciplinary teams.
Unemployment Insurance Rules
Currently, claimants can lose 25 percent of their weekly benefits for each day they work, whether they worked just one hour or a full shift on that day. Under the new rules, a worker could work up to four hours in a week without being penalized.
Assist Workers in Getting Vaccinated
To protect workers and those returning to work, improve public health, and help the State's economic recovery, public and private employers would be required to provide four hours of paid leave for up to two COVID-19 vaccinations for each employee. We do not believe at this time that voluntary providers will be reimbursed for this required paid leave.
Budget details are still developing and we will share additional information as it becomes available.
