Last week, legislative leaders in both houses and Governor Cuomo announced their agreement on the state fiscal year (SFY) 2021-2022 budget. Our friends at the New York State Association of Health Care Providers (HCP) provided the following update on key budget items for NY homecare providers.

The Overall Deal

After a year of battling COVID-19, state leaders touted their work on the $212 billion spending plan. The Governor focused his remarks on the strong fiscal management and relentless pursuit to secure the federal support to balance the budget, investment to reimagine, rebuild and renew New York in the aftermath of the worst health and economic crisis in a century.

The budget agreement includes:

  • $29.5 billion in aid to schools;

  • $29 billion in public and private green economy investments;

  • $2.4 billion for rent and homeowner relief;

  • $2.4 billion for child care;

  • $2.1 billion for excluded workers;

  • $1 billion for small business recovery;

  • Legalization of mobile sports betting;

  • Directs $2.3 billion in federal child care resources to expand availability, quality and affordability of child care across the state;

  • Enacts employer child care credits.

The budget also includes comprehensive nursing home reform legislation to help ensure facilities prioritize patients over profits. These reforms establish minimum thresholds for nursing home spending of 70 percent of revenues on direct resident care and 40 percent of revenues on resident-facing staffing, capping profits at five percent, and targeting unscrupulous related party transactions. Excess revenues recouped by the state will be deposited into the existing nursing home quality pool for further investments for nursing homes to meet high quality standards.

What’s in it for Home Care?

Disappointingly, there was not a great deal included in the budget to assist home care providers. In the end, there was no repeal of the Licensed Home Care Services Agency (LHCSA) Request for Offers (RFO). Nor was there any proposal directed to Fair Pay or any proposal that would provide additional wages to home care workers.

What about Enhanced FMAP?

Recall that the latest stimulus bill, the American Rescue Plan Act of 2021, provides a 10% increase in the federal medical assistance percentage (FMAP) for home and community-based services (HCBS).

The budget appropriates, but does not provide for any particular use for this funding. Instead, the language appropriating the $1.629 billion provides vague terms for its use. The language provides that funds shall be used in accordance with applicable federal laws, rules, regulations and guidance. The language goes on to provide that such funds may be expended via non-competitive contracts or non-competitive grants in a manner to be determined by the Department of Health (DOH/the Department). The language finally provides that DOH shall provide the chairs of the legislative fiscal committees with quarterly reports on the purposes, expenditures, contracts, and sub-allocations for which the funds are used.

This approach appears to tie in with decisions being made by the Centers for Medicare and Medicaid Services (CMS) regarding guidance to states about how to spend FMAP allocations. This may also tie in with President Biden’s announcement last week of investing $400 billion in HCBS for the caregiver economy as part of the Biden administration’s infrastructure spending proposal.

HCP will be engaging in discussions with the legislature, Governor and the Biden administration to ensure that home care providers will have access to these funds for appropriate uses.

Other Items of Interest to Home Care:

Medicaid Budget

  • Restores $60 million in Managed Care quality pool payments;

  • Restores $22.5 million for Recruitment and Retention funding;

  • Restores $94 million in 1 percent across the board rate reduction;

  • Extends the Medicaid Global Cap through State Fiscal Year 2023-24 and requires detailed quarterly updates to the legislature on Medicaid utilization and spending.

  • Telehealth reform by allowing providers and patients to participate in telehealth from anywhere in the United States for delivery and payment purposes, and by adding certified peer recovery advocates as eligible telehealth providers.

  • Prohibit services being provided under the Traumatic Brain Injury (TBI) or Nursing Home

  • Transition and Diversion (NHTD) Waiver from being transitioned to Medicaid Managed Care until January 1, 2026.

As HCP reported last week, the budget includes language that allows for a limited increase in Fiscal Intermediaries (FIs) to be awarded contracts to operate in the Consumer Directed Personal Assistance Program (CDPAP) and to ensure appropriate geographic representation in the program. The DOH is required to survey all eligible applicants from the initial procurement on additional selection criteria to determine if they are not-for-profit, if they were an FI before 2012, if they serve individuals with intellectual and developmental disabilities, if they serve minority communities, and where the FI is physically located.

DOH will then determine if more awards are needed and will make those awards based on the scores achieved in the original procurement.


As lawmakers’ work on the budget concludes, HCP will be at work determining what the implementation of this budget means and how it will impact policies from last year’s budget still to be implemented. HCP’s work for the home care industry will continue by advocating for the fair dispersal of enhanced FMAP funding, reimbursement for COVID expenses, and repeal of the LHCSA RFO, to name a few.

This summary was reposted with permission from HCP. To learn more about HCP or to become a member, please visit