Empire Justice has worked extensively on Medicaid home care issues from both the consumer and worker perspectives. Our efforts have taken many forms. Through informal advocacy, fair hearing representation, and state and federal litigation, we represent Medicaid recipients attempting to overcome barriers to accessing home care. We provide training and technical assistance to other advocates working with home care recipients and applicants. We provide feedback to and advocate directly with the State on issues affecting home care recipients through our roles on the Managed Long-Term Care Quality Incentives and Nursing Home Managed Care Transition workgroups; through monthly Medicaid Matters New York (MMNY) meetings with Department of Health (DOH) managed care staff; as co-chair of MMNY and Health Care for All New York’s Public Programs Group, which meets regularly with Marketplace Medicaid staff; and through our positions on the steering committees of MMNY and the Coalition to Protect the Rights of New York’s Dually Eligible. Last year we co-authored a report put out by MMNY and the National Academy of Elder Law Attorneys, New York Chapter, entitled “Mis-Managed Care,” which documented widespread illegal reductions in Medicaid personal care hours by several Managed Long Term Care plans. These experiences have helped shape the perspectives we provide today.
While our home care policy and federal litigation work is statewide, our individual advocacy for home care consumers and workers, as well as technical assistance work has been primarily outside of New York City and Long Island. For Medicaid consumers and their advocates in the regions in which we have worked, the existence of a Medicaid home care workforce shortage is undeniable. Although our clients encounter numerous barriers to accessing the home care to which they are entitled, the shortage of aides has been the biggest obstacle to care by far. The home care workforce shortage is not new, but it is reaching crisis proportions attributable to a constellation of factors including an aging population; stagnation of already low home care wages; limited public transportation; and the relatively recent, and long overdue, application of Fair Labor Standards Act (FLSA) travel and overtime requirements to home care workers. Some agencies are capping aide hours to avoid FLSA requirements, resulting in further reduction of the available workforce.
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