Gov. Andrew M. Cuomo’s mantra to rein in New York State spending means the squeeze on nonprofit human services agencies is only expected to get tighter.
Providers of services for the developmentally disabled, in particular, are facing a new way of doing business with the state, which will likely force some agencies to relinquish programs, resulting in other nonprofits growing to provide the services.
The state is following the lead of others in moving toward a managed care system for the developmentally disabled in which a regional HMO-style organization would manage residential needs, medical care and other services.
Instead of paying individual agencies directly on a contract basis – the norm in New York for at least the past 30 years – the state plans to work through entities called Developmental Disabilities Individual Support and Care Coordination Organizations, also known as DISCOs, in dispensing hundreds of millions dollars statewide.
“They’re talking about running all of the money and all of the processes through this entity,” said James M. Boles, chief executive officer of People Inc., the area’s largest provider of services to the developmentally disabled. “The entity would basically contract with the state.”
The state and federal governments expect to achieve some measure of Medicaid savings, or at least a slowdown in cost increases, through the new model, which will combine the delivery of health care with other services for individuals with developmental disabilities, Boles said.
Significant waiting lists for many programs, including specialized housing, already exist, causing advocates for the developmentally disabled to express concern that the new direction will exacerbate delays for needed services.
The National Council on Disability, for example, found in a recent analysis of managed-care programs for people with disabilities that many state proposals “place too little attention on the outcomes being sought for people receiving services, such as a better quality of life, control over their services and supports, full participation in community life, protection of individual rights, employment options for working age adults, etc.”
Several agencies in Western New York already are working together to implement the state’s plan, with an eye toward ensuring that clients see no disruption or drop-off in services.
The collaborative known as Person Centered Services of Western New York will apply in March to receive designation as a DISCO for a 17-county region that stretches from Buffalo to the Finger Lakes and includes about 160 nonprofit agencies that provide disability services for more than 15,000 people.
The collaborative currently consists of seven agencies: People Inc.; Lifetime Assistance in Rochester; Community Services for the Developmentally Disabled; Heritage Christian Services in Rochester; Aspire of WNY; Cantalician Center for Learning and Pathway’s Inc. in Corning.
Boles is serving as chairman of the board of Person Centered Services of Western New York, which hopes to become a pilot DISCO for the state.
“More than anything, it will be the entity that will purchase services for people with developmental disabilities from anybody who provides any Medicaid funded service,” said Mark R. Foley, president and chief executive officer of Community Services for the Developmentally Disabled.
The DISCO application is an opportunity for area service providers to have a strong voice in dealing with inevitable changes, including the setting of rates of reimbursement to agencies, Foley said.
Pressure to spend less is “a political reality, and it’s a real-world reality that we need to face,” said Foley, who is secretary for the board of Person Centered Services of WNY. “It’s something we’re all going to face, so let’s be thoughtful about it.”
Agencies increasingly will need to integrate sound business practices into their service delivery, he said.
Earlier this month, People Inc. took over the developmental disabilities unit of DePaul Community Services in Rochester, which includes three group homes, a day habilitation program, a respite program and several community-based, individual support programs.
DePaul, which still provides affordable housing, senior living and mental health and addiction prevention programs, including some services in Western New York, decided that the programs for the developmentally disabled no longer fit with the agency’s core mission, Boles said.
As a result, People Inc. is growing this year by about 300 employees, 400 clients and $5 million.
Foley expects those kinds of changes to continue as agencies respond to reduced rates of reimbursement and seek more efficient ways of operating.
“We will eventually see mergers. We will see consolidations,” he said. “Some of the stronger, larger organizations will grow because of that.”
Community Services for the Developmentally Disabled is preparing for the move to managed care by re-examining staff.