Home-Based Care Providers Fear They’re Being Squeezed Out of Medicaid

New York state’s 2020 final budget includes a Medicaid policy provision that has caused serious concern among home-based care providers and advocates. Those groups are now asking lawmakers to overturn the provision.

Broadly, the original Medicaid policy issue was that the state authorized the New York Department of Health to essentially decide which home-based care providers could participate in the state’s Medicaid program.

A Request for Offers (RFO) process forced home care providers — even ones that had existed for years — to apply for selection in order to continue providing services under Medicaid. That included agencies already licensed by the state to provide these services.


“This authorizes an arbitrary, unilateral role for the Department of Health to cut home care through the issuance of a licensed home care services agency [RFO],” Kevin Kerwin, the VP of public policy at New York State Association of Health Care Providers (HCP), said during a press conference Tuesday.

In addition to HCP, the press conference included two other advocacy organizations: the Home Care Association of New York State (HCA-NYS) and LeadingAge New York.

The outcome of the RFO application process is still not clear, but one is expected soon, which has providers worried. It’s unclear which providers will pass the threshold that now stands in their way — or what that threshold even is.


To overturn any sort of outcome that would squeeze providers out through RFOs, state lawmakers introduced Senate Bill 6640 last month. The bill would strip the Department of Health of its current ability to offer a limited amount of contracts to Medicaid providers.

Whether or not that bill will make it through and become law is still up in the air.

“Passing this bill is urgent to eliminate uncertainty, avoid disruption of services, maintain patient access to services and avert a crisis in home care,” Kerwin continued. “Failure to do so will be harmful to home care and the patients it serves, creating completely avoidable turmoil, chaos, unpredictability, gaps in care and lack of access to service.”

The potential squeezing out of providers is yet another hurdle that New York’s home-based care operators have had to overcome in the last year.

The state also threatened to cut the recruiting and retention budget for providers in its original budget proposal and failed to include a provision that would increase funding for home-based care workers.

“We support — and we call for the legislature and governor to urgently pass, and sign — Assembly Bill 7304 and Senate Bill 6640,” Al Cardillo, the president and CEO of HCA-NYS, said during the press conference. “That will repeal the 2020 pre-pandemic action that authorized this RFO process. It would reset the table, according to the now mid-pandemic world and all of its revelations about the health care system, the citizenry and the needs of patients across the board.”

Assemblymember Richard Gottfried — the longest-serving member of the state’s assembling body — presented the bill that would help get rid of the Department of Health’s RFO process.

“Requiring [home-based care agencies] to compete for an arbitrarily limited number of contracts with DOH in order to continue operation in the Medicaid program was an erroneous overreach,” Gottfried said in a memo accompanying the bill. “This is a misguided and underhanded attempt to choke off the availability — and use — of home care under Medicaid.”

The associations also pointed out during the press conference that New York’s recent adjustments to home-based care funding and processes are juxtaposed with the new federal administration’s efforts to encourage care in the home moving forward.

Besides general rhetoric advocating for home-based care and its workers, President Joe Biden has proposed investing $400 billion to enhance home- and community-based services (HCBS) in the U.S.

“The Biden administration recognized this growing need and is prioritizing significant investments in HCBS for the vulnerable individuals needing long-term care, and RFO is out of line with this need,” Kathy Febraio, the president and CEO of HCP, said during the press conference. “We need to make the changes necessary to allow more people to remain independent in New York. Limiting the number of home care providers will make it harder, not easier, for New Yorkers to get care at home.”

At a time when home-based care is garnering more support than ever, these advocacy organizations are concerned that the RFO process is deliberately shrinking New York state’s home care infrastructure.

“We call on the legislature to pass this bill … before it’s too late,” Kerwin said.

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