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New
York State Budget 2003
EISEP/CSE
Merger – Why it is Not Good Policy
Governor’s proposal
consolidates CSE and EISEP – cuts it by $3.5 million and attempts
to shift the costs to the counties. The reality of this proposal
is:
1.
Will cut programs and services funded under these programs throughout
the state – with New York City being the biggest loser.
- Counties
are already overmatched – many counties have put additional
dollars into these programs over the years because they have been
flatfunded. Most counties are already meeting the 30% share and
more – they will not be required to, nor will they have
the resources to add additional money – this means they
will be without the $3.5 million form the state and an additional
$4 million in state only funded Planning and Implementation (P&I)
dollars
-
Based on New York’s funding formula, New York City receives
about 43% of the money based on their senior population. New York
City’s aging budget is primarily financed through City taxes
– they will lose about 43% of the $3.5 million.
2.
Consolidating the CSE and EISEP Program is not the right move at
this time. It is not the right move in the context of a budget that
reduces dollars and in the context of the Olmstead Supreme Court
Decision. CSE funds a variety of services – including home-delivered
meals, case management, transportation, respite, adult day and more.
EISEP Provides non-medical in-home supportive services to the frail
elderly – At least 50 % of the EISEP dollars MUST be spent
on in-home supports. Impact of this proposal.
-
Eliminates the EISEP Language from statute – EISEP was formed
because there was a need for case management services and in-home
supportive services that keep frail, elderly individuals living
at home. The supports provided include – case management
(linking to other support services) shopping assistance and meal
preparation, personal care, housekeeping and chore services, medication
management, bill paying, etc. There would be no mandate to provide
these services if the language is eliminated.
-
Case management and in-home services are labor intensive and costly.
Counties would be allowed not to provide these services and direct
the money elsewhere as they see fit.
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EISEP targets low-income elderly who are frail – it also
targets lower income minority elderly.
-
There are already over 6,000 seniors on EISEP waiting lists, consolidating
the programs and eliminating EISEP language would increase the
waiting lists and immediately increase Medicaid applications –
90% of EISEP clients are at or below 150% of the poverty level
and would be able to spend down to Medicaid.
-
EISEP keeps seniors off Medicaid. EISEP clients are older, frail
seniors with no formal support system near them (family, friends)
and have been identified as needing assistance with ADL’s
(Activities of Daily Living –bathing, dressing, ambulating,
etc) and IADL’s (Instrumental Activities of Daily Living
– meal preparation, shopping assistance, etc.) These individuals
would be forced to apply for Medicaid to get the care they now
receive under EISEP.
-
Medicaid funded community-based care that is similar to EISEP
costs 5 times more and nursing home care costs between $70,000
- $95,000 per year depending on where you live in the state. These
are the wrong options.
3. The integrity of the ESIEP Program not only needs to be maintained,
it needs to expand.
-
EISEP has been flatfunded for years – it has large waiting
lists throughout the state.
-
Case management is a critical component to providing cost-effective
community services. Case managers are highly trained and are skilled
at maximizing community resources and putting together sound care
plans that meet the holistic needs of the seniors it serves.
-
In-home support services are appropriate and can maintain someone
for a very long time appropriately and safely.
-
EISEP services have been proven to keep seniors living independently
and living safely. It has reduced the state and county Medicaid
burden by offering an appropriate alternative.
4.
CSE is a flexible funding stream that allows the counties, with
little public input or oversight, to spend those dollars as they
desire. It allows them to fill service needs and gaps based on the
needs of their own populations.
-
CSE is an important program and should remain flexible.
-
EISEP should not be folded into CSE and become one big fund that
has little to no input from community providers on how the money
is spent.
5.
EISEP and CSE are critical pieces in the community-based continuum
of care and must be maintained and expanded.
-
In a post-Olmstead environment, we should be investing, over time,
in programs such as these that are proven cost effective, have
proven their value in delaying and preventing nursing home placement,
and met the desires of the individuals and families by allowing
them to remain and be served at home – all goals of Olmstead.
-
New York’s senior population will rise from 3.2 million
in 2000 to over 6 million in the next 15 years – we should
be investing, not cutting these services.
-
Reducing the funding to these services will mean an increase in
Medicaid applications and Medicaid costs at the state and county
level.
6. EISEP has been New
York’s commitment to provide home care and case management
to elderly who cannot obtain such services under Medicaid.
7. The cost of providing
services in rural areas with scattered populations and limited service
providers was recognized through EISEP. Small counties receive a
minimum base allocation and the state funded 100% of the costs of
planning and implementation. For small counties, $30,000 of planning
and implementation funds are provided annually. The proposed changes
would eliminate the state funded P&I dollars and base the funding
formula on the total number of 75+ elderly, thus further disadvantaging
smaller counties, isolated areas or areas with census undercount.
8. Under the new proposed
CSE the state will no longer provide any planning and implementation
funding. Counties will be able to take 10% of their program costs
for local administration. However, small counties will receive far
less than the $30,000 planning money they receive currently. In
addition, they will now have to match any administrative funds with
a 30% local match. This places additional financial burdens on local
governments and is particularly harsh to small rural counties.
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