Medicaid Redesign Watch

New York is in the process of completely revamping how the state delivers Medicaid-funded long-term services and supports.

As the state moves to mandatorily enroll elders and people with disabilities into managed care plans—and moves from fee-for-service to capitated payments—all aspects of the system will be affected.

Our Project

PHI Medicaid Redesign Watch is tracking these changes, with a particular emphasis on the impact on home care workers, who are the backbone of New York’s long-term care delivery system.

This three-year project will record, analyze, report --and even intervene--as events unfold. Our goal is to limit disruption for both consumers and workers, and to ensure that changes to the system result in both better quality care and better quality jobs for those on the frontlines.

Our initiative is funded by the Ira W. DeCamp Foundation, the Ford Foundation, the Altman Foundation, and the Bernard F. and Alva B. Gimbel Foundation. Additional partners in this project include Wider Opportunities for Women (WOW) and the National Employment Law Project (NELP).

MRW Publications

The Impact of Wage Parity on Home Care Aides: How Better Wages Affect Public Benefits, Tax Credits, and Family Incomes -- Examines how a recent increase in the wages of New York City home health aides affects workers' access to public benefits and tax credits such as the Earned Income Tax Credit.

Medicaid Redesign Watch #1: Wage Parity for Home Care Aides -- Describes the wage disparity that led to the need to create a new “minimum wage floor” for all home care workers in the greater New York City area, where approximately two-thirds of the state’s home care workers are employed. In addition, it explains why wage parity is essential to successful Medicaid reform, describes some of its early implications and unintended consequences, and makes recommendations regarding further implementation.

Medicaid Redesign Watch #2: The Impending Threat to the NYC Home Care System -- Examines the increased labor costs that will emerge as New York State shifts from a Medicaid fee-for-service system toward a managed-care system. The financial pressures are likely to be so intense that employers committed to high job quality for home care workers could be squeezed out of the industry. Three recommendations that may help these “high-road” employers remain solvent are offered.

Medicaid Redesign Watch #3: Improving New York's Home Care Aide Training System -- Focuses on changes the New York State Department of Health has made to the Home Health Aide Training Program requirements since 2010. The paper also highlights continuing challenges to building the skilled, stable workforce that will be required as New York’s health care system emphasizes home and community-based over institutional care.

Medicaid Redesign Watch Employer Advisory: Compensation for "Sleep-in" or "Live-in" Cases -- Addresses the factors that must be taken into consideration in determining compensation for 24-hour home care shifts and reviews payment rates required under New York state law. Specifically, the fact sheet examines how meal time, sleep time, and overtime pay factor into a 24-hour home care worker's compensation.

Medicaid Redesign Watch Employer Advisory: Required Cell Phones for Home Care Aides -- Provides guidance to home care employers about the issue of cell phone use by home care aides. Notes that the use of cell phones to check in with employers is increasingly used in New York to combat fraud, but often aides must resort to using their own phones to make these calls.

Medicaid Redesign Watch Employer Advisory: Upgrading Home Attendants to Home Health Aides: Is Training Time Compensable? -- Outlines the various factors that determine whether New York home care providers are responsible for compensating their employees for time spent in training. It also explains recent legal opinions that are relevant to the issue.