New York’s New Budget:

More Pain Than Gain for Health and Human Services

When the Executive Budget was released on February 1, 2011, it promised pain in a lot of areas.
Services to children and families were particularly hard hit as were economic security for low-
income people and some health and mental health programs. The ambitious and sometimes
controversial recommendations of the Medicaid Redesign Team were wrapped into the Executive
Budget late in the game, making analysis of layered implications for vulnerable populations
difficult. While there were a few significant restorations in the final budget, there were also
many deep cuts. The dollar amounts are noted below; details about the programmatic and
human impacts are as yet unclear.

To see the final budget documents, visit the Senate and Assembly websites.

Child and Family Services

The Executive Budget’s proposal to create a Primary Prevention Incentive Program (PPIP) was
rejected, but funding was reduced by 50% for many programs that localities use to help at-
risk children and youth. (See chart)

Program 2010-11 Budget Final Budget

Healthy Families New York $23,288,200 $23,288,200
Hoyt Trust Fund $ 1,243,700 $621,850
Kinship Contract $ 677,500 $388,750
Community Optional Preventive Services $24,249,500 $12,124,000
(COPS)
Youth Development and Delinquency $21,245,350 $10,622,675
Prevention Program (YDDP)
Special Youth Delinquency Prevention $ 6,998,050 $3,499,025
Program (SDPP)
Runaway Homeless Youth $ 4,711,600 $2,355,800
Caseworker Caseload Ratio $ 1,514,000 $757,200
Settlement Houses $ 900,000 $450,000
Total Funding $84,827,900 $54,107,500

State Central Register Clearance Fees were increased from $5 to $25 and child care providers
are no longer exempt. This change took effect on April 8th. The fee represents a significant cost
shift from the state to community-based organizations and child care workers, who are often
low-income workers.
Funding for the Healthy Families New York (HFNY) home visiting program was fully
restored ($23M). Funding for COPS, which partially funds the Nurse-Family Partnership
(NFP) program and funding for the Hoyt Family Trust Fund, which partially funds The
Parent-Child Home Program (PCHP), were decreased. Additional money for NFP that was
funded through Temporary Assistance to Needy Families (TANF) was not restored ($2 M).
With full funding for HFNY, it appears that the state may go forward with its application for
federal home visiting funding. This funding will help to expand and improve home visiting
services. Implications of the reductions to NFP and PCHP are as yet unclear.

Localities will pay an increased share for adoption subsidies, as the state share is reduced
from 73.5% to 62%. The state share for Committee on Special Education (CSE) placements
was reduced from 36.8% to 18.424%. Over 95% of all adoptions are eligible for subsidies.
Decisions regarding CSE placements are made by local school districts with funding coming
from local departments of social services’ budgets. The formula change places an increased
burden on local budgets.

Funding for the Advantage After School Program (AASP) was maintained at $17.2 M
(General Fund) and $500,000 in TANF funds were restored. The total FY12 allocation of
$17.7 M represents a decrease of $4.8 M in overall funding for AASP compared to the FY11
funding level of $22.5 M. Research on afterschool programs shows that they are cost-effective;
every dollar invested in high-quality afterschool programs saves taxpayers roughly $3,
according to a study by the Rose Institute at Claremont McKenna College. Factoring in benefits
from crime reduction raises that savings to $8-$12 for every dollar invested in an at-risk child.
The reductions translate to cuts of thousands of afterschool program slots.

Funding for child care subsidies was maintained but the loss of $5 M in federal stimulus
funding will result in an estimated 6,000 lost slots. SUNY/CUNY funding was reduced to
$1,634,000 and funding for Child Care Demonstration Projects was reduced to $3,395,000.
SUNY/CUNY child care helps to ensure child care for low-income students enrolled in a two-
year college program. The Child Care Demonstration projects provide much needed subsidies
to working families.

The previously approved increase in the public assistance grant will be delayed by one year,
to 2012. The state share for the Safety Net program was reduced from 50% to 29%, leaving
localities a 71% share of costs. The promise of a 30% increase is maintained in the 2011-12
Budget, but the last installment of a 10% increase is delayed for another year.

Kinship Guardianship Assistance will be funded through the Foster Care Block grant for one
year. Implementation of the Kinship Guardianship Assistance Program began April 1, 2011.
The enacted budget allows localities to use the Foster Care Block Grant to fund Kinship
Guardianship Assistance for the current budget year. However, the Foster Care Block Grant is
already fully utilized in meeting the needs of foster care children.

Some restorations were made to TANF-funded programs. Funding for these programs has
decreased considerably over the last two years. (See chart)

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 2009–10 2010-11 2011-12
TANF PROGRAMS Funding Level Funding Level Funding Level
ACCESS – Welfare to Careers $ 500,000 $ 250,000 $ 250,000
Advantage Schools $ 11,391,000 $11,213,000 $ 500,000*
Alternatives to Detention/Residential $ 10,752,000 $ 6,000,000 0**
Placement
ATTAIN – Technology training $ 7,000,000 0 0
Bridge $ 8,503,000 $ 1,000,000 $ 102,000
Build NY 0 0 0
Career Pathways $ 10,000,000 $ 5,000,000 0
Caretaker Relative $ 1,998,000 $ 250,000 $ 51,000
Centro of Oneida $ 125,000 0 $ 25,000
Child Care SUNY/CUNY $ 3,400,000 $ 1,644,000 $ 334,000***
Child Care Demonstration Projects $ 10,900,000 $ 5,265,000 $ 3,395,000
Community Solutions to Transportation $ 2,200,000 0 $ 112,000
Disability/Advocacy Program (DAP) $ 1,000,000 $ 483,000 $ 98,000
Displaced Homemakers $ 5,600,000 $ 1,605,000 $ 546,000
Educational Resources $ 3,000,000 $ 125,000 0
Emergency Needs for the Homeless $ 2,000,000 $ 125,000 $ 176,000
Green Jobs Corps Program $ 5,000,000 $ 2,000,000 0
Health Care Jobs $ 5,000,000 $ 2,000,000 0
Home visiting $ 5,822,000 Moved to General Fund 0
Intensive Case Services $ 3,000,000 0 0
LIVES: VESID employment services $ 1,500,000 0 0
Non-residential Domestic Violence $ 3,000,000 $ 1,449,000 $ 510,000
Nurse-Family Partnership $ 5,000,000 $ 2,000,000 0
Preventive Services $ 18,792,000 $ 6,000,000 $ 610,000
Refugee Resettlement $ 1,425,000 $ 500,000 $ 102,000
Rochester-Genesee Regional $ 2,000,000 $ 403,000 $ 82,000
Transportation Authority
Settlement House $ 6,000,000 $ 1,000,000 $ 500,000
Strengthening Families through Stronger $ 2,764,000 0 $ 200,000
Fathers
Summer Youth Employment $ 35,000,000 $ 15,500,000 $15,500,000
SHIP: Supplemental homelessness $ 5,000,000 $ 1,006,000 $ 205,000
intervention program
Supportive Housing for Families $ 5,000,000 $ 2,500,000 $ 508,000
Transitional Jobs $ 5,000,000 $ 5,000,000 0
Wage Subsidy $ 14,000,000 0 $ 950,000
Wheels for Work $ 7,000,000 $ 409,000 $ 144,000
Subtotal: $208,672,000 $72,727,000 $24,900,000

FFFS fund $964,600,000 $960,000,000 $951,000,000

Child Care Subsidies $392,967,000 $392,900,000 $392,967,000
Subtotal: $1,357,567,000 $1,352,900,000 $1,343,967,000
TOTAL: $1,566,239,000 $1,425,627,000 $1,368,867,000

*The Executive Budget proposed a $5 M increase in the general fund budget for Afterschool programs
and eliminated $11.2 M in TANF funding. The final budget accepted the increase in the general fund and
increased TANF funding from $0 to $500,000, representing an overall decrease in funding of $4.89 M.
**Alternatives to residential placement programs were replaced by the Supervision and Treatment
Services program in the general fund.
*** Additional funding included in the Higher Education Budget.

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The budget provides $76.3 M in capped funding for secure and non-secure detention at 49%
state share or for alternatives to placement at 62% state share. A new Supervision and
Treatment program is funded at $8.2 M with no local share required. A 60-day notification
for closure of facilities is required for the budget year with criteria that must be considered
before each closure. In addition, the Persons in Need of Supervision (PINS) population is
eligible for services funded by the Supervision and Treatment program and for foster care or
detention placement when needed. The changes in juvenile justice funding aim to shift
practice toward community-based treatment and services and reduce capacity by 376 beds, or
31%. Additional funds are also provided to improve OCFS facilities for those who must be
placed, continuing the reforms required by the U.S. Department of Justice.

Health, Including Mental Health

$20 M is invested in supported housing and support services for psychiatrically disabled
individuals leaving New York City adult homes. It is anticipated that this amount will be
sufficient to proceed with the development of housing this year. This fund is part of a multi-
year plan to provide funding for additional supported housing and support services for
psychiatrically disabled individuals to leave New York City adult homes.

The Center for Health Workforce Studies (CHWS) was funded at $196,000. The CHWS is the
state-funded entity that engages in health workforce analysis. This is a reduction from last
year’s funding of $392,000. The Executive Budget proposed eliminating funding for CHWS. The
funding reduction undermines the state’s capacity to understand a critical component of health
care delivery at the same time significant system changes are underway.

The proposal for increases to copayment amounts for Medicaid Fee-for-Service and Family
Health Plus, and to implement copayments for Child Health Plus was rejected. Public health
insurance programs are designed to serve low-income and vulnerable populations and must
remain affordable. Research suggests that cost sharing may inhibit enrollees from seeking
necessary and cost-effective preventive and other care.

The budget contains two across-the-board reductions in Medicaid. The first is a uniform
across-the-board reduction in Medicaid equal to 2% of Medicaid payments. Facilities
licensed by the Office of Mental Health, the Office of Persons with Developmental
Disabilities and the Office of Alcoholism and Substance Abuse Services are exempt. The
second is a Medicaid Global Cap limiting Medicaid spending growth to medical Consumer
Price Index. Advocates remain concerned that a hard cap on Medicaid expenditures as across-
the- board reductions will hit vulnerable safety net providers, programs and communities the
hardest, although there is language intended to protect safety net providers in underserved
communities.

The budget begins the three-year process of expanding managed care enrollment to all
populations. This includes very vulnerable populations, such as disabled children and
children in foster care. Enrollment in managed care does not guarantee improved coordination
of care and can, in fact, bring numerous and significant new problems. Extreme caution and
consideration must go into every detail of this proposal and an essential component must be
active consumer engagement in planning, implementation and ongoing monitoring.

The budget authorizes the state to implement utilization controls on behavioral health.
SCAA continues to believe that the state should not pursue short-term savings through fewer

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visits at the risk of long-term poor health outcomes and higher costs to individuals,
communities and the Medicaid system.

Reimbursement to county health department for services in the “optional” category of

Article VI was eliminated. These services include dental clinics, emergency medical services,
laboratory services and home health care. These cuts and cost shifts will make it more difficult
for county health departments to prevent and address health needs in their communities.

Rates paid to providers for Early Intervention (EI) services were reduced 5% instead of the
proposed 10%. EI reduces special education costs, increases parent involvement, and produces
significantly better outcomes in teenage and adult health, behavior and productivity.

Higher Education

The budget maintained last year’s reduction in the maximum Tuition Assistance Program
(TAP) allowance for students in two-year degree programs from $5,000 to $4,000. The
continued reduction represents a significant decrease for students and will likely have a
negative impact on those low-income students who most need assistance to attend and/or
remain in college.