Hochul Abandons Home Care & Independent Living
Restore access to the Nursing Home Transition and Diversion (NHTD) Medicaid Waiver
What is the Consumer Directed Personal Assistance Program?
Community Meals Hosted at STIC
Celebrating Black History Month
New Fashionable Fundraiser in April
Lift Available to Transport Wheelchairs and Scooters
Sub-Minimum Wage: A Relic of a Lesser Time
STIC Receives $1,000 Donation from Auchinachie Cares
STIC - AccessAbility Information
Hochul Abandons Home Care & Independent Living
By Jennifer Watson
Each spring, New York’s budget process begins with the Governor introducing the Executive Budget, which serves as the starting point for negotiations with the two houses of the State Legislature.
Although the Governor’s 2026 budget includes substantial new health care investments, those resources are very disproportionately directed toward institutional settings rather than the home- and community-based services that support people with disabilities and older adults to live independently. This funding imbalance contradicts decades of policy progress and the clear goal of promoting independent living and community integration.
New York must prioritize investments that expand access to community-based supports, not policies that continue to reinforce institutional systems at the expense of independence and choice. This is particularly troubling as the state is moving to finalize its first Olmstead Plan, more than 25 years after the Supreme Court’s decision requiring states to provide services in the most integrated setting.
If New York is serious about fulfilling the promise of Olmstead, it must invest in home care and other supports that allow people to remain in their homes and communities. This includes restoring access to the Nursing Home Transition and Diversion (NHTD) Medicaid Waiver, a program that has helped thousands of older adults and people with disabilities transition out of nursing homes or avoid institutional placement altogether by providing specialized community-based services. Unfortunately, access to the waiver was essentially closed to new participants through a hard cap on enrollment, leaving many eligible people without a pathway to receive the services they need to remain in the community. The State must also repeal the MRT II home care eligibility cuts implemented last September, which raised the threshold for qualifying for personal care and Consumer Directed Personal Assistance Program services by requiring assistance with additional activities of daily living. These changes make it much harder for people with significant needs to access essential supports, increasing the risk of health crises, hospitalization, or unnecessary nursing home placement.
STIC is also calling on the Governor and Legislature to restore critical Independent Living funding and make meaningful investments in community-based services as part of the 2027 State Budget. These investments are essential to ensure New Yorkers with disabilities can live independently, remain in their communities, and access the supports they need to thrive.
Independent Living Centers (ILCs) across the state provide no-cost, consumer-controlled services to thousands of New Yorkers with disabilities each year. Yet the Executive Budget released earlier this month fails to restore last year’s $750,000 legislative augmentation for the statewide network and once again excludes ILCs from the 1.7% targeted inflationary increase (Cost of Living Increase, or COLA) provided to other human services organizations.
For decades, Independent Living Centers have saved the State millions of dollars by helping people avoid unnecessary institutional placement, gain meaningful employment, and reduce long-term Medicaid costs. The State should invest in what has proven to work: community-based services that help people remain independent, employed, and living in their own homes.
Yet the Governor’s budget funds the statewide ILC network at just $16 million, far below what is needed to sustain services across New York. The ILC network has been chronically underfunded for more than a decade.
We urge the State to increase base funding for Independent Living Centers to $25 million, including restoration of last year’s $750,000 legislative augmentation along with additional investment to support the cost-effective services ILCs provide. We also ask that bill A.2590/S.1580 be included in the final budget so that ILCs receive the same Cost of Living Adjustment provided to other human services organizations.
In the current economic landscape, stagnant funding effectively amounts to a cut. Rising costs for salaries, benefits, utilities, and other operating expenses continue to increase each year, while funding for Independent Living Centers has remained largely flat. Without adjustments to keep pace with inflation, ILCs are forced to do more with less. Despite these financial pressures, Independent Living Centers continue to play a critical role in the delivery of community-based services across New York.
Last year, the Legislature explicitly mandated that Independent Living Centers remain part of the Consumer Directed Personal Assistance Program (CDPAP) because of our long history and deep experience with the program. ILCs were involved in the program’s early development and have served as conscientious and consumer-controlled Fiscal Intermediaries from the beginning. New York’s ILCs understand how to operate CDPAP in a way that reflects its core principles of consumer direction, independence, and accountability. ILCs were never part of the problem, but we can and must be part of the solution.
Unfortunately, the current implementation of the statewide fiscal intermediary model has too often sidelined Independent Living Centers. This undermines the Legislature’s original intent and creates unnecessary barriers for consumers trying to access or maintain services. Legislative action is necessary to clarify the role of facilitators and ensure transparency and accountability in how CDPAP is administered. Two bills have been introduced that would help address these issues.
S.9320 would require the statewide fiscal intermediary to utilize facilitator agencies like ILCs and would prohibit the statewide FI from providing direct facilitation services, which creates an inherent conflict of interest.
The Home Care Transparency Act (S.9142) would bring much-needed transparency and accountability to the program so that policymakers, consumers, and the public can better understand how CDPAP is being administered.
CDPAP was built on the principles of consumer direction and independence. These bills help ensure those principles are preserved and that the program works for the people it was created to serve. More broadly, the State’s budget choices should reflect a consistent commitment to community integration, but unfortunately that is not the case in the Executive Budget.
The Governor is once again proposing cuts to the Access to Home program, which funds critical home modifications for people with disabilities, from $5 million to just $1 million. This proposal moves the State in exactly the wrong direction. For more than a decade, STIC has urged New York to increase base funding for Access to Home to at least $10 million so that people with disabilities across the state can obtain the modifications they need to remain in their homes and communities.
Access to Home is one of the few programs specifically designed to remove physical barriers that prevent people with disabilities from living independently. Often, a relatively modest modification such as a ramp, widened doorway, roll-in shower, or grab bars can make the difference between someone remaining safely in their home or being forced into an unnecessary and far more expensive institutional placement. Cutting funding for a program that both protects independence and saves the State money is a short-sighted policy choice.
Ensuring that people with disabilities have access to safe, accessible housing is fundamental to dignity, autonomy, and full participation in community life. Rather than reducing funding for Access to Home, New York should be expanding this program so that people with disabilities can continue to live in their homes, remain connected to their communities, and avoid unnecessary institutionalization.
The policies and funding choices made in this year’s budget will determine whether New York upholds its commitment to equal rights for all or strips people with disabilities and older adults of the freedom to live in their own homes and communities. Limiting access to community-based services undermines decades of progress and violates the civil rights principles established under the Americans with Disabilities Act and the Olmstead decision.
Restore access to the Nursing Home Transition and Diversion (NHTD) Medicaid Waiver
By Laura Hulbert
The Nursing Home Transition and Diversion (NHTD) Medicaid Waiver program was established in 2007, developed by the disability community to assist Medicaid-eligible adults and seniors with disabilities by providing a unique and necessary set of community-based services to individuals who are currently in nursing homes or are at risk of nursing home placement, so that they might access services in the community as an alternative to institutionalization. For many years, the waiver program operated through nine Regional Resource Development Centers (RRDC) under contract to the NYSDOH with no concerns regarding the number of people served, or the cost neutrality of the program. The program transitioned thousands of people from nursing homes and prevented placement for thousands more. Rapidly, the NHTD waiver became one of the state’s most effective community-based Medicaid program options for adults with physical disabilities and seniors. As enrollments increased over the years NYSDOH also increased the available program slots to meet the needs of these highly vulnerable New Yorkers.
The primary demographic of those served in the waiver are people with dementia, who require supervision for safety, cues and prompts to remember when and how to complete their activities of daily living, along with our elderly, chronically ill, and physically frail citizens. By virtue of being a Medicaid waiver program, the services provided are unique to the needs of these populations and are not available under any other Medicaid program in New York State.
Absent the supports and services this waiver provides, disabled adults and seniors will have no option for community-based care. Most will be consigned to nursing homes far from their communities and their families, resulting in far higher costs to the Medicaid program — assuming there are enough nursing home beds available to take them. Emergency room visits and hospitalizations will become more frequent, creating further stress on our hospital systems, which will result in longer wait times and fewer available beds.
In 2012, managed long-term care (MLTC) Medicaid was instituted in New York State as a gambit to constrain costs. MLTC plans began administering community-based home care services such as CDPAP or PCSP; they were paid a capitated per-member-per-month Medicaid rate to meet the needs of their consumers, by their very nature highly variable. Like any insurer, they had to balance the costs of treating their consumers, plus administrative overhead and, hopefully, profit, against revenue generated from enrolling consumers.
Beginning around 2020, the MLTC plans realized they could refer all their high utilizers of personal care to the NHTD waiver. In doing so the MLTC plans maximized their profits while shifting the financial costs and enrollment numbers to the NHTD waiver program. The RRDC offices began noting this trend and raising the red flag to the NYSDOH back in 2020, but no actions were taken to address the issue of the large influx of referrals. MLTC plans were referring over five hundred people monthly to the RRDCs and the RRDCs were instructed to continue enrolling eligible individuals without regard to cost. MLTCs are offloading their most expensive individuals into NHTD via the RRDCs, and the RRDCs were instructed to continue enrolling people without regard to cost.
Then the supervising entities blamed NHTD for skyrocketing costs. This is like crowding all the sick people into nursing homes and then being surprised by the spike in nursing home mortality rates. (Oh, wait, this same New York State government did exactly that during the pandemic. Well, they’re consistent.)
The State’s Financial Plan delineates how costs related to the waiver have increased significantly in recent years due to the above. According to data provided by the Department of Health, 95% of all referrals to NHTD from the last 3 years came from MLTCs, and the average cost of individuals coming from MLTC to NHTD is $245,000/year, which is $100,000 more per year than people coming from other sources and far exceeds the waiver’s cost neutrality participant cost of $187,065/year.
These increased, unsustainable costs are a direct result of the Managed Long Term Care (MLTC) companies transferring their higher-cost members from their managed care premium to the NHTD waiver to improve the MLTC bottom line.
MLTC only wants to carry customers who don’t cost them any money. Unfortunately, that is not the way insurance is supposed to work. The capitation rates are calculated for the entire risk pool, not just the low-cost portion of it. Blackjack is a very different game if all the face cards are removed from the deck. This is essentially what’s happening when the high-value “cards”—those individuals whose care-cost averages $245,000/year—are removed from the MLTC “deck.” With financial motivations built into the MLTC capitation rates not just permitting but incentivizing these actions, it isn’t health insurance, it’s human arbitrage.
Enrolling people without regard to cost could not continue forever, and as the saying goes, something that cannot go on forever will stop. The governor’s budget crunchers noticed the surging increases in the costs of the waiver and as a result, last year’s budget included language proposed by the governor’s team to institute a hard cap on enrollment in the NHTD waiver, restricting access to the program completely. This closes access to the NHTD waiver statewide effective this January, despite cost neutrality not being a statewide problem. DOH has stated on their website that they will not be taking any referrals for the NHTD waiver. None.
The consequence of the hard enrollment cap is a loss of access to this program for people facing nursing home placement or who want a community-based alternative to their current institutional placement in a nursing home. Good oversight by DOH would stop the cost-shifting MLTC saboteurs from flooding NHTD with all their expensive cases and destroying the NHTD business model. Good management would be to work with the DOH-contracted administrators of the program, the Regional Resource Development Centers (RRDCs), to develop targeted solutions to the problem in those places where the problem was most urgent. Predictably, the state DOH found a third way: a dumb, lazy, counterproductive one that rewards the cynical scofflaws that created the problem and harms the vulnerable citizens the NHTD waiver was created to help.
The Hochul government has “reformed” CDPAP, leaving it far worse than they found it. Now they’re “reforming” NHTD. In both cases they’re letting for-profit corporations and private equity consortiums manipulate the system to maximize their profits at the expense of the taxpayers and against the well-being of their vulnerable clients. For what primary purpose do these programs exist? Are they to improve the fortunes of our state’s elderly people and those with disabilities, or are they just means to fatten the profits of corporations and private equity firms? The Hochul Administration is acting as if it is the latter and not the former.
The Governor suggests people who would be best served by the NHTD waiver as it existed be instead referred to the MLTCs that manufactured this problem by referring all their high-needs members who are physically and/or cognitively disabled to the NHTD program. Refusing access to the established NHTD program that then results in unwanted institutionalization is a violation of federal law, specifically the Americans with Disabilities Act and the Supreme Court’s Olmstead ruling of 1999. But illegality isn’t the worst part. Neither is the fathomless stupidity of undermining lower-cost solutions (community-based care) that generate preferable outcomes in favor of higher-cost solutions (institutionalization) that generate unfavorable outcomes. The worst part, the unforgivable part, is the blithe cruelty. Those individuals who should be cared for best will live shorter lives with less freedom and joy than they might otherwise.
This enrollment cap must be reversed. At a time when New Yorkers are facing gratuitously harmful cuts emanating from Washington, the State must restore access to this essential program.
What is the Consumer Directed Personal Assistance Program?
By Sue Hoyt
CDPAP is a Medicaid-funded program that allows people who are approved for personal care assistance to hire, train, supervise, schedule, and terminate their own Personal Assistants, including most family members, a neighbor, or a friend. CDPAP is an alternative to traditional home care. CDPAP allows personal assistants to help with housekeeping, bathing, dressing, eating, skilled nursing, and many other daily tasks.
Eligibility:
Eligibility for Medicaid CDPAP is determined through an assessment by the New York Independent Assessor Program (NYIAP). A consumer in need of CDPAP who has Medicaid would call NYIAP at 855-222-8350 for an assessment. NYIAP will also have an Independent Practitioner do a physical evaluation with the consumer.
Assessments and physicals can be done over the phone, via telehealth, or in person.
A CDPAP Facilitator provides support with your CDPAP services and administration.
Southern Tier Independence Center (STIC) is an approved facilitator for the Consumer Directed Personal Assistance Program (CDPAP). We are partnered with Public Partnerships, LLC (PPL), the statewide Fiscal Intermediary, to provide guidance, assistance, and ongoing support for your CDPAP services.
STIC as a CDPAP Facilitator, as an Independent Living Center (ILC): We take a person-centered, consumer-directed approach to CDPAP facilitation, reinforcing the values of independence, choice, and self-determination. This includes working with consumers and Personal Assistants (PA) in multiple aspects of their CDPAP services and PA requirements.
STIC’s Service Areas for CDPAP: Broome, Cayuga, Chemung, Chenango, Cortland, Delaware, Madison, Onondaga, Otsego, Schoharie, Schuyler, Seneca, Steuben, Tioga, Tompkins, and Yates Counties.
Contact a STIC CDPAP Facilitator at: Phone: 607-724-2111 or Email: cdpa@stic-cil.org
PPL as the statewide Fiscal Intermediary (FI) can also assist with all the above, as well as processing PA payroll, including benefits (PTO, workers’ compensation, and disability), monitoring PA’s state-mandated training, EVV training, and managing consumer authorizations for services.
PPL Customer Service:
Monday – Saturday, 8:00am – 8:00pm ET
Phone: English: 1-833-247-5346 Spanish: 1-833-281-0927 TTY: 1-833-204-9042
Customer Service Email: nycdpap@pplfirst.com
For other languages and PPL resources, visit: https://pplfirst.com/cdpap
Community Meals Hosted at STIC
By Matthew Requa
We are thrilled to be partnering with 1plate1Community, BIG ZUES Barbecue, and Good Neighbors NY to host free Community Meals!
This past December 17th, STIC opened its doors to the community and, along with our partners, offered a sumptuous feast to those in need. In addition, we gave away donated clothing of all sorts, non-perishable food items, and personal hygiene products like toothpaste and soap. Kids in attendance got to visit with Santa and his elves. It was a big success, so we’re going to make it a regular event.
On Wednesday, April 1st, please join us from 4 to 6pm at STIC for an evening of neighborly hospitality and delicious food. You have the option of takeout or pulling up a chair and connecting with your family, friends, and the community over a warm meal, beverages, and dessert. Please register at the following link if you plan to attend: www.1plate1community.org. We’ll also, again, be giving away hygiene products, clothing, and packaged food items.
STIC welcomes donations for our Community Meal, and our Food Pantry and Clothing Closet. Nonperishable food items, hygiene products, clothing, and reusable bags can be dropped off at 135 East Frederick St, upstairs in the reception area during our business hours of Monday through Thursday, 8:30am to 4:30pm, and Friday, 8:30am to 3:00pm.
Celebrating Black History Month
By Matthew Requa
We were blessed to have Reverend Dr. Damond A. Wilson give a presentation at STIC today in honor of Black History Month. He spoke passionately about the integration of all marginalized populations, including people of color, LGBTQIA+, and the disabled community. He also spoke about fighting against honoring people who supported racist ideologies and, instead, celebrating cultures of all kinds. Reverend Dr. Wilson, among wearing many other hats, is president of the Broome & Tioga NAACP, a pastor at Trinity AME Zion Church, and Director of Operations at The Broome County Council of Churches. He recently led a successful drive to rename the former Columbus Park in downtown Binghamton to Center City Park, improving the inclusivity of the space and highlighting both its past and its future. Our sincere gratitude to Reverend Dr. Wilson for educating us and for the generous donation of his time.
New Fashionable Fundraiser in April
By Matthew Requa
Soak up the thrifty, spring vibes at our 1st annual Vintage Sip N’ Shop. This swinging event will feature a wide variety of groovy and stylish clothing, unique antiques, delicious samples of local libations, basket raffles, a 50/50, and more. Drink bracelets are $20. Admission to the event is free.
Interested in being a Sip N’ Shop vendor? Visit the following link: www.stic-cil.org/sip-n-shop. All proceeds support people with disabilities.
Be sure to attend and tell all your friends to help make our premier Vintage Sip N’ Shop fundraiser a timeless smash.
Lift Available to Transport Wheelchairs and Scooters
By Danny Cullen
STIC has acquired a lift to transport a four-wheel scooter or a power wheelchair. It mounts on the back of a vehicle; the vehicle must be equipped with a trailer hitch.
It is available free to anyone who may benefit from it. If you have questions or interest, please contact Danny Cullen at 607-724-2111, extension 325.
Sub-Minimum Wage: A Relic of a Lesser Time
By Sue Ruff
STIC was founded as part of the Independent Living movement, which has been advocating for over a half century that people with disabilities deserve the same rights and opportunities as the rest of us. Prominent among these is the opportunity to make a living, to contribute to the economy, and to have a sense of purpose and efficacy — put most simply, to work. The federal government has instituted ADA, IDEA, Olmstead, and more landmark measures establishing job supports and reasonable accommodations for those with disabilities to participate fully in modern commerce. In addition, New York State is working to increase the numbers of people with disabilities in employment through initiatives like Employment First as well as customized and supported employment.
Our society has advanced mightily towards treating all its people with the dignity and respect they deserve as full and equal members of the human family, and the contributions of all are to the benefit of all. This is part of the foundational American mission of life, liberty, and the pursuit of happiness, and our very first Constitutional mandate to pursue a more perfect union. We have made great strides in that quest and should celebrate them with pride. This is to the benefit of not just people with disabilities, but all of society, for an injustice towards one is an injustice to all.
And yet, there are still inequities that persist from a less enlightened past. One of these we have come excruciatingly close to eradicating is the issuance of 14(c) certifications from the U.S. Department of Labor approving “sheltered workshops,” in which people with disabilities, almost all developmental or intellectual ones, work for a “sub-minimum wage.”
This outdated program, established in the 1930s, was an exception carved into the New Deal’s minimum wage law — perhaps defensible then, but indefensible now. What was once framed as compassion has become a paternalistic and exploitative loophole. The federal minimum wage is still $7.25 an hour, unchanged since 2009 and utterly insufficient in the inflation-ridden economy of the 2020s. Yet 1,400 workers in New York and over 40,000 nationwide still earn less than that — the majority of them under half that amount, and many far below even that. This continues despite ample proof that most workers under 14(c) certificates, when given the right supports, can perform real, valuable work that merits a full and fair wage — work our own laws recognize as deserving better pay than this sanctioned injustice.
The number of people working for subminimum wage has decreased about 90% in the past quarter century. The economic model of a business that can only break even if they pay their laborers less than $7.25 an hour is unsustainable in the 21st-century economy. Twenty states have outlawed sheltered workshops either by legislation or administrative action. In 2024, the Biden Administration issued a Notice of Proposed Rulemaking that would enjoin the Secretary of Labor from issuing 14(c) certificates after a phase-out period of three years; the rulemaking process had not concluded by the end of Biden’s term and the Trump Administration retracted the proposed new rule. The writing is on the wall — sheltered workshops will eventually be gone for good in the United States one way or another.
However, STIC maintains this should happen sooner rather than later; the existence of subminimum wages must cease as a matter of civic hygiene. Their persistence is an insult to the inclusive community STIC wishes to advance. The future can, and must, include competitive, integrated employment opportunities for all. Sheltered workshops perpetuate a nearly century-old stereotype that people with disabilities are not capable and cannot contribute to their community’s labor force.
Employment for real wages is a pathway out of poverty. STIC has worked for many decades to end sub-minimum wages, and we have helped hundreds of people find and keep jobs in our region. A bill sponsored by New York Assembly Member Steck, A1006B, and its companion bill in the New York State Senate, S28C, sponsored by Senator Skoufis, will functionally end sheltered workshops in New York, and we strongly support it; its time has come.
STIC Receives $1,000 Donation from Auchinachie Cares
By Jennifer Watson
STIC is grateful to have received a generous $1,000 donation through the Auchinachie Cares program, which provides support to local nonprofit organizations making a difference in the community. Auchinachie is a locally owned and operated Binghamton-based company that has been serving the community for over 100 years, providing plumbing, heating, and cooling, while maintaining a strong commitment to community support and engagement. Since its inception, the Auchinachie Cares program has contributed over $100,000 to nonprofits across the region.
This donation will directly support STIC’s mission of empowering people with disabilities to live independently and fully participate in their communities.
In response to growing needs in our community, STIC has expanded efforts to address food insecurity and facilitate access to basic necessities by launching a food and hygiene pantry and a clothing closet for the individuals and families we serve. We are also partnering with One Plate One Community and Big Zues BBQ to host a community meal at our main office in Binghamton on April 1 from 4:00–6:00 p.m. Community members are invited to stop by for a free, hot meal, along with a food and hygiene product giveaway and clothing distribution. A portion of the funds provided will help support these efforts.
STIC extends its sincere appreciation for this continued investment in our community and for supporting programs that promote independence, dignity, and opportunity for people with disabilities.
Trivia Night Breaks Record
By Matthew Requa
Our 3rd annual STIC Trivia Night fundraiser raised the bar, becoming by far our most successful Trivia Night by a landslide. Thank you to Sons of Italy in Endicott for hosting us and for the delicious food, our amazing sponsors, and of course, all the teams who played to win and helped support people with disabilities. We hope you are all looking forward to next year.