Albany Times Union, Sunday, October 2, 2022

It’s just heartless greed

Some insurance companies may be pocketing money meant for raises to alleviate a critical shortage of home care workers.

To comment: TULETTERS@TIMESUNION.COM

New York has a desperate shortage of home care workers to take care of sick, disabled, and frail people. Recognizing that dire situation, state lawmakers and Gov. Kathy Hochul put $7.7 billion in the state budget for wage increases to help retain and attract these vital employees.

But now it looks like hundreds of millions of dollars of that money may end up going to insurance companies that are keeping it for themselves.

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It’s a level of greed and opportunism in the face of a crisis that ought to shock the sensibilities of the governor and Legislature. And Attorney General Letitia James should look into whether there’s a civil or criminal case to be made here. Even it it doesn’t rise to criminality, it’s as offensive an abuse of public funds as the rampant fraud we witnessed in the false claims for unemployment benefits early in the COVID-19 pandemic.

As the Times Union’s Rachel Silberstein reports, the money was supposed to support minimum-wage increases of $2 an hour this year and $1 an hour next year. The increases were slated to start Oct. 1.

But some private insurance companies, in negotiations with home care agencies, are offering only 20 cents to 50 cents more an hour in reimbursement rates. The New York State Association of Health Care Providers says that as of last week, the vast majority of home care agencies reported no insurance companies even talking to them about raising reimbursement rates. Some even want to decrease rates.

The result, then, would be even worse than if the state had offered no new money at all. Because providers would have to pay more per hour but not be made whole by the insurance companies, they’d likely have to cut staffing and overtime pay and turn away clients insured by companies that won’t cover the wage hikes.

Certainly this sounds immoral, and it may not be legal. The state Department of Health says that under federal rules concerning how much money from premiums insurers and managed-care organizations have to spend on direct care, they can’t keep the state funds. The department intends to reinforce that message.

State leaders should deliver a message of their own — that keeping these public funds from getting to the workers is an egregious breach of trust. It’s not just about the pay, but about the health of an industry that so many vulnerable people depend on. Insurance companies are not just shortchanging the providers, they’re thwarting an important public health initiative.

Capital Region lawmakers — state Sen. Neil Breslin, D-Delmar, who heads the Senate Insurance Committee, and Assemblymen John T. McDonald III, D-Cohoes, and Phil Steck, D-Colonie, both members of the Assembly Insurance Committee, should call on their respective committees to convene and demand insurance executives come to Albany and explain themselves. And they should work with the Hochul administration to develop, if necessary, any new laws to force insurers to pass the money on, and retroactively pay anything they failed to do. And a penalty, if possible, might help drive home the point.

In the meantime, we offer some simple, clear, nonbureaucratic advice to the insurance industry: Do the right thing.

Article from Albany Times Union, Friday, September 30, 2022

Experts: All $7.7B from state for home care staff won’t reach paychecks

By Rachel Silberstein

ALBANY — Hundreds of millions of dollars in state funding set aside to raise the pay of home care workers are likely to end up in the pockets of private health insurance companies, industry experts say.

After years of campaigning for better pay, home care workers in New York state won $7.7 billion for wage increases in the state budget approved in April.

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The money is intended to help end New York’s worst-in-the-nation home care shortage. The funding is for a $3-per-hour minimum wage increase — $2 this year, $1 more next year. Workers and advocates are calling on the state to compel insurance companies to pay their fair share.

But private insurance companies, who negotiate reimbursement rates with home care agencies, are offering pay bumps as low as 20 cents or 50 cents per hour, according to offers from two insurance companies shared with the Times Union with the company name redacted.

According to Bryan O’Malley, executive director of the Consumer Directed Personal Assistance Association, talks with insurance companies can hardly be classified as “negotiations,” as home care agencies have little leverage.

“The only way we can force any kind of negotiation is if the Department of Health gets involved,” which is rare, O’Malley said.

According to a survey by the New York State Association of Health Care Providers conducted last week, 87 percent of home care agencies say they have had zero insurance companies reach out about the rate change. Of those that did hear from insurers, 61 percent reported being offered decreased rates. Most respondents said that the insurance companies are actively putting up roadblocks to even discussing a new rate.

“The only way we can force any kind of negotiation is if the Department of Health gets involved.”
— Bryan O’Malley, Consumer Directed Personal Assistance Association executive director

The home care raises are set to go into effect Oct. 1 — so if the state doesn’t step in immediately, private insurance companies could keep 80 percent of the money intended for low-income home care workers, advocates say.

The added cost to home care agencies could trickle down to workers in the form of reduced hours and overtime pay and turning away consumers with certain insurance plans, O’Malley said.

A state Department of Health spokesperson said that insurance companies, or managed care organizations, can’t keep the state funds due to federal “medical loss ratio” requirements. The medical loss ratio refers to the percentage of premium dollars that a health plan spends on medical claims and quality improvements versus money spent on overhead costs.

“The department informed plans that they should start coordinating with their provider network to make the necessary provider contract updated on Aug. 16 when we delivered the updated per hour amounts and rate schedules,” Monica Pomeroy said. “Additionally, on Sept. 12, the department organized a second webinar where we reiterated this information with MCOs and providers.”

The health department will keep reiterating its previously released guidance with health plans to ensure statutory compliance, she added. Providers are urged to connect with their contact at the Department of Health if they feel the plans are being unreasonable.

“The new per-hour values, which include all elements of the home care worker wage, are sufficient and actuarially certified to meet the new state statutory requirement as of Oct. 1, according to all the interactions and input we have had to date from both MCOs and providers,” Pomeroy said.

The New York Health Plan Association, a member organization of health care providers in the state, issued a statement Thursday calling on the state to “finalize rate packages to bring clarity to the process” of distributing the wage increases.

“Fair wage funding should be utilized to increase worker salaries, and health plans have been working diligently to adjust their rates to providers to reflect the changes included in the FY23 State Budget,” Eric Linzer, president and CEO of NYHPA, said in the statement. “Unfortunately, in some cases, the funding made available to health plans is not enough to support increases of the magnitude that providers are seeking, while in others some providers are not seeking the funds for workers but rather for profit.”