fair-access-initiative-inc-150409

2026-27 FY Budget Priorities

Sun, 08 Feb 2026 02:52:58 GMT

Strengthen Home Care Workforce Operations -

Streamline training, onboarding, and administrative function

Overview

New York’s home care system continues to face persistent workforce shortages, high administrative costs, and caregiver retention challenges. Individual agencies are currently responsible for duplicative onboarding, training, credentialing, and compliance functions—creating inefficiencies, inconsistent standards, and unnecessary costs that ultimately affect patient care access.

This proposal consists of a pilot program in partnership with the Department of Health (DOH), to serve as a unified workforce infrastructure supporting home care agencies and workers statewide. The model expands on existing DOH-managed systems—such as the Criminal History Record Check (CHRC) and Home Care Registry—by centralizing additional workforce functions through a shared, technology-enabled platform.

Policy Problem

Agencies duplicate onboarding, training, and credential verification at significant cost
Workforce records are fragmented across employers, limiting portability and efficiency
Caregivers face inconsistent training pathways and limited professional development
Administrative burden contributes to agency strain and worker turnover

These structural inefficiencies weaken workforce stability and reduce care continuity for patients .

Policy Solution

The centralized ecosystem would function as a shared service hub, responsible for:

Standardized Onboarding & Credentialing
Centralized hiring intake, credential verification, and compliance tracking
Workforce registry maintaining credentials, training history, and regulatory status
Training & Professional Development
State- and federally compliant standardized training programs
Technology-Driven Administration
Centralized HR, compliance, and credential management systems
Real-time data sharing among agencies, the ecosystem, and DOH
Modeled after existing CHRC and DOH registry infrastructure
Caregiver Health Benefit Integration
Hybrid health coverage model providing primary and limited acute care benefits
Medicaid remains available for emergency or higher-level care
Reduces reliance on Medicaid for routine services and supports preventive care

Expected Outcomes

Workforce Stability: Reduced turnover and improved retention
Operational Efficiency: Lower administrative costs through shared services and automation
Improved Job Quality: Clear career pathways, consistent training, and health supports
Quality of Care: More reliable, well-trained workforce delivering consistent care statewide

Live-In Home Care Reform -
Aligning DOH and DOL Standards

Policy Problem

New York’s live-in home care system is governed by conflicting Department of Health (DOH) and Department of Labor (DOL) standards. DOH permits agencies to pay 13 hours of a 24-hour live-in shift when aides receive required sleep and breaks. DOL interpretations and court decisions have nevertheless required payment for all 24 hours—even when agencies comply with DOH rules.

At the same time, unclear DOH supervision rules conflict with federal DOL requirements for duty-free, uninterrupted meal and rest breaks, creating legal exposure and operational confusion.

Current impact on home care providers:

Widespread litigation and escalating legal costs
Reduced availability of live-in services
Increased risk of institutional placement for medically fragile patients
Provider withdrawal from 24-hour home care

Policy Solution

Create one clear, enforceable statewide standard that aligns DOH and DOL requirements that protects compliant providers from duplicative wage claims and preserves access to 24-hour home-based care.

Codify the 13-Hour Rule: Define live-in care as 13 compensable hours within a 24-hour shift (including required sleep and breaks).
Preempt Conflicting Interpretations: Statutory clarity that supersedes inconsistent DOL guidance or judicial interpretations.
Safe-Harbor Protections: Liability protection for agencies with verifiable compliance records (e.g., EVV, time logs).
Curb Abusive Litigation: Direct the Attorney General to address duplicative or bad-faith class actions.

Required Regulatory Clarification

Direct DOH to clarify that supervision requirements do not apply during federally protected, duty-free meal and rest breaks, during which aides are not required to remain on-site or under employer control.

Fiscal Impact

Budget neutral
Potential indirect savings from reduced litigation, administrative burden, and avoidable institutional placements

Streamline Nursing Assessments
Reducing Duplication, Accelerating Care, and Modernizing Home Care Oversight

Overview

The FAIR Access Initiative proposes the Universal Nursing Assessment. This proposal is not a new program—it is a structural correction. By aligning existing tools, modernizing data sharing, and eliminating unnecessary duplication, UNA strengthens New York’s home care system while protecting patients, workers, and taxpayers.

Policy Problem

New York’s home and community-based care system requires multiple duplicative nursing assessments for the same individual across programs—often within days or weeks of one another. Licensed Home Care Services Agencies (LHCSAs), Managed Long Term Care plans (MLTCs), PACE programs, Health Homes, and primary care providers each conduct overlapping assessments using similar data but different formats.

This fragmentation delays access to care, increases administrative costs, and contributes to nurse and care manager burnout. The delays also frustrate patients with repetitive evaluations. Moreover, duplicative assessments waste substantial state Medicaid resources without improving outcomes.

Policy Solution: Universal Nursing Assessment (UNA)

The FAIR Access Initiative proposes the Universal Nursing Assessment (UNA) as a single, standardized, nurse-led clinical assessment that is completed once at the point of care and shared securely across authorized providers.

Key Features

Built on the existing Uniform Assessment System–New York (UAS-NY)
Completed by a Registered Nurse or qualified care manager
Shared in real time via SHIN-NY / Qualified Entities
Serves as the authoritative clinical baseline for a defined validity period (e.g., 90 days)
Allows targeted program-specific addenda—not full reassessments

UNA eliminates duplicative base assessments while preserving clinical oversight, patient choice, and program integrity.

Fiscal Impact (Public-Info-Based Estimate)

Using CMS-reported NY LTSS enrollment (~289,500 users) and conservative RN labor cost proxies:

Estimated annual gross savings:
$40 million – $175 million per year
Savings driven by eliminating 1–2 duplicative RN assessments per LTSS user annually
Does not include downstream savings from faster care initiation or reduced institutional utilization

Integrated Home Care Ecosystem
A Sustainable Alternative to New York’s Current Home Care System

Overview

New York’s home care system is facing significant fiscal and workforce pressures that threaten access to care for seniors, people with disabilities, and medically complex patients. Across-the-board reimbursement cuts risk destabilizing providers, worsening workforce shortages, and increasing avoidable hospitalizations and institutional care. The FAIR Access Initiative proposes the Integrated Home Care Ecosystem as a sustainable, cost-effective alternative that achieves savings through coordination and efficiency—not service reductions—while strengthening quality, access, and continuity of care.

Policy Problem

Home care agencies operate under Medicaid reimbursement rates that do not adjust to rising labor and operating costs.
Fragmentation across providers, payers, and care managers leads to duplicative services, poor coordination, and higher downstream costs.
Workforce instability and agency closures threaten patient access and continuity of care.
Cuts to home care risk shifting costs to more expensive settings such as hospitals and nursing homes.

Policy Solution: Integrated Home Care Ecosystem

The Integrated Home Care Ecosystem aligns key partners across the care continuum to deliver coordinated, patient-centered home care services. Participating entities include:

Licensed Home Care Service Agencies (LHCSAs)
Primary care practices
Health Homes and care management organizations
Managed care organizations and other payers
Community-based and supportive service providers

Through formal coordination, shared accountability, and data-driven care planning, the model improves outcomes while controlling costs.

Fiscal & System Impact

Reduces avoidable hospital admissions, emergency department use, and institutional placements.
Preserves access to home care while mitigating long-term Medicaid costs.
Strengthens provider viability and protects the home care safety net statewide.

Modernize Home Care Funding
Aligning Fair Pay with Sustainable Medicaid Funding

Overview

New York State has long championed fair wages, workers’ rights, and equitable access to care. Home care agencies and caregivers support efforts to raise the minimum wage and establish a livable wage for the workforce serving the State’s most vulnerable residents.

However, unlike other industries, home care agencies cannot adjust prices or negotiate reimbursement to absorb rising labor costs. Caregiver wages are funded entirely through Medicaid reimbursement rates set by Managed Care Organizations (MCOs) under State oversight.

When wage mandates increase without corresponding reimbursement adjustments, agencies face an untenable choice: comply and risk insolvency, or reduce services and quality to remain operational. The FAIR Access Initiative calls for aligning wage policy with reimbursement policy to ensure fair pay for workers and sustainable access to care for patients.

Policy Problem

Wage mandates rise without funding alignment: State minimum wage increases are not automatically reflected in Medicaid reimbursement rates.
Agencies lack rate-setting authority: Licensed Home Care Services Agencies (LHCSAs) rely on MCO-negotiated rates that often fall below the true cost of care.
Inconsistent and inequitable MCO practices: Some MCO incentives favor volume or referrals, disadvantaging smaller and independent agencies regardless of quality outcomes.
Data-driven methodologies are underutilized: MCO rates frequently fail to reflect Department of Health (DOH) Cost Reports and regional cost data used by the State in rate-setting.

Absent reform, these structural imbalances will continue to drive agency closures, workforce attrition, and reduced patient access—particularly in rural and underserved communities.

Fiscal Reality

A $1.00/hour wage increase results in $1.64/hour in total employer cost once mandated payroll taxes, benefits, and administrative expenses are included—representing a 64% increase beyond the wage itself.

Per caregiver (30 hours/week): ≈ $2,560 annually
750 caregivers: ≈ $1.92 million annually
1,000 caregivers: ≈ $2.56 million annually

With approximately 250,000 caregivers statewide, even modest wage increases create substantial unfunded liabilities when reimbursement is not adjusted proportionally, threatening agency solvency and continuity of care.

Policy Solution

The FAIR Access Initiative proposes aligning wage policy and Medicaid reimbursement through the following reforms:

Automatic Rate Adjustment
Statutorily require Medicaid reimbursement rates to automatically adjust with any State-mandated wage increase.
Apply a standardized multiplier (e.g., 1.64×) to reflect the full employer cost of wage increases.
Review and update the multiplier biennially.
Cost-of-Living Adjustment (COLA) Indexing
Incorporate regular COLAs into home care reimbursement rates to prevent recurring inflation-driven funding gaps.
Transparency and Pass-Through Enforcement
Require MCOs to demonstrate compliance with State-directed rate increases through provider-level reporting and auditable verification that funds reach direct care staff.
Data-Driven Base Rate Methodology
Mandate use of DOH Cost Reports and regional cost data in MCO rate negotiations to ensure consistent, evidence-based reimbursement.
Administrative Transition Support
Provide temporary implementation funding to support necessary updates to billing, payroll, and contract systems.

Policy Impact

Advances New York’s livable wage goals in a fiscally responsible manner.
Protects patient access to Medicaid-funded home care statewide.
Stabilizes the caregiving workforce and prevents provider attrition.
Promotes transparency, accountability, and data-driven oversight.
Strengthens collaboration among providers, MCOs, and the State.

Health Budget Testimony

Sun, 08 Feb 2026 02:49:35 GMT

February 8, 2026

FAIR Access Initiative, Inc.

51 Maryland Street

Dix Hills, NY 11746

Chairpersons, Ranking Members, and Members of the Legislature,

My name is Sasha Guillaume, and I am the Founder and President of the FAIR Access Initiative, a provider-led association representing home care agencies across New York State. It is an honor to represent our members and to submit this testimony to the Members of the Legislature on their behalf.

The mission of FAIR Access Initiative is to strengthen the home care industry by working in partnership with the Legislature, the Executive, and the Department of Health as responsible stewards of the Medicaid program. Our focus is on identifying inefficiencies, reducing waste, and improving long-term sustainability, not expanding programs or increasing spending.

FAIR Access was formed in the wake of the CDPAP transition, which exposed the risks created by a fragmented and disunified industry response. When cost growth, operational complexity, and oversight concerns reached a tipping point in the Consumer Directed Personal Assistance Program, the resulting policy response was sweeping and centralized. Regardless of one’s perspective on that outcome, it demonstrated that when provider-led solutions are absent, corrective action can be broad and disruptive.

FAIR Access exists to prevent that pattern from repeating elsewhere in home care.

Today, fragmentation continues to drive unnecessary Medicaid spending. Multiple entities often assess, document, supervise, and manage care for the same patient. These overlapping assessments and care planning functions can be streamlined to eliminate repetitive services that result in Medicaid paying multiple times for the same work.

FAIR Access proposes a Universal Nursing Assessment, built on the existing UAS-NY, completed once and securely shared across authorized providers. This is not a new program. It is a structural efficiency that recognizes work already being performed and eliminates redundancy.

We also support an Integrated Home Care Ecosystem that aligns plans, providers, and care managers around shared assessments, reconciled care plans, and interoperable data. Better alignment improves continuity of care while reducing administrative duplication and unnecessary cost.

FAIR Access Initiative also sees significant opportunities to reduce redundancy through greater workforce regulatory alignment. While workforce stability is at its core a care issue, it is also a critical fiscal issue. We can build upon existing Department of Health eligibility and credentialing infrastructure to centrally manage in-service and continuing education requirements through a secure registry accessible to providers. This would eliminate repetitive training requirements for staff working across multiple agencies, while maintaining consistent standards and compliance.

Additionally, FAIR Access seeks to work collaboratively with Albany to address the unintended consequences of misaligned mandates that have led to unnecessary litigation and destabilization of provider networks. Conflicting regulatory standards, particularly in live-in care, have reduced participation in one of the most cost-effective alternatives to institutional placement.

FAIR Access Initiative is not here to ask for new funding. We are here to partner with the State to identify waste, improve transparency, and ensure that legislative mandates align with operational and fiscal realities.

Our goal is to offer provider-led solutions that protect Medicaid dollars and to work collaboratively as trusted stewards of a program that New York’s most vulnerable residents depend on.

Thank you for the opportunity to submit this testimony.

Regards,

Sasha Guillaume, President

FAIR Access Initiative, Inc.

Executive Budget Released and FAIR Advocacy Day

Sun, 25 Jan 2026 05:04:42 GMT

Join FAIR for Home Care Advocacy Day on Tuesday, February 3!

To RSVP for FAIR’s Advocacy Day, please contact Alyssa Lovelace at alyssa@hgmlobby.com .
To review FAIR’s budget requests in detail, members are encouraged to click here .

2026 Executive Budget Highlights

Lawmakers officially convened for the 2026 Legislative Session on Tuesday, January 7 . Breaking with recent tradition, Governor Kathy Hochul delivered her State of the State Address on January 13 , followed by the release of the Executive Budget on January 20 .

The Governor introduced a $260 billion balanced budget that includes no new income tax increases and maintains more than $14.6 billion in reserves. Her agenda this year is anchored in the theme of affordability, with a strong focus on improving quality of life for all New Yorkers—particularly older adults and those relying on long‑term care services.

Key Budget Proposals Affecting Health Care & Aging Services

Medicaid Investments

The Executive Budget proposes $38.2 billion for New York’s Medicaid program, including $1.2 billion in new federal funding generated through an assessment on Managed Care Organizations (MCOs). These funds will be distributed to health care providers and related programs.

Support for New York’s Growing Older Adult Population

New York is now the fourth-oldest state in the country, with 4.6 million residents aged 60 and older—a number expected to climb to 5.4 million by 2030. Many older adults face mobility limitations, challenges with daily living activities, and the growing burden of chronic conditions.

Recognizing these trends, the Governor’s budget advances several initiatives aimed at strengthening care access and enhancing economic stability for older New Yorkers.

Specifically, the Governor’s budget includes:

Hospital at Home: General hospitals could provide acute medical services in a patient’s home without needing a home care agency license. Under the proposal Participating hospitals must submit annual operating cost data to the Department of Health. The DOH would establish Medicaid reimbursement rates for services provided under this model. This initiative would significantly expand the amount of acute care delivered in patients’ homes.

Personal Care Administrative Fees: The Executive Budget proposes to cap personal care fee‑for‑service administrative reimbursement at 15% of total costs.

Increased investments in Naturally Occurring Retirement Communities (NORCs): These community-based programs provide older adults with support and resources to help them age in place, reducing the need for institutional care.

Renewed funding of $35 million to reduce waitlists for non-medical in-home services such as personal care, case management, home-delivered meals, congregate meals, and transportation services. This investment will help address immediate service gaps that many seniors face.

An educational initiative aimed at increasing awareness among clinical providers and their staff about options for community-based palliative care, hospice care, and the importance of advance care planning . This will help ensure older adults have access to care that meets their needs in a timely manner.

A short-term, multi-agency council to identify all available benefits for older adults across various state and federal programs. This initiative will assist seniors in accessing benefits related to Veteran’s services, tax reductions, nutrition assistance, prescription drug support, and medical care.

Expansion of eligibility for the Senior Citizen Rent Increase Exemption (SCRIE) and Disability Rent Increase Exemption (DRIE) programs: The Governor proposes raising the income eligibility threshold from $50,000 to $75,000 for seniors in New York City, with similar provisions for other local jurisdictions opting into the program.

$250 million in new capital funding to accelerate and expand the development of affordable housing for seniors. This funding will produce thousands of affordable homes, ensuring that older New Yorkers have access to safe, affordable living environments.

CDPAP: While the Executive Budget does not include new CDPAP provisions, the Governor highlighted the savings realized from last year’s CDPAP reforms.

Expanded efforts to protect older adults from abuse, scams, and fraud, which have become increasingly prevalent as seniors spend more time online and are targeted by bad actors.

These proposals align with the Governor’s broader vision for making New York more affordable for its residents, particularly seniors, who often face financial and logistical barriers as they age.

FAIR Access Initiative Policy Platform

We’ve published a clear, accessible policy overview outlining the key reforms needed to stabilize the workforce, streamline patient assessments, clarify regulations, and ensure fair reimbursement for providers.

These reforms strengthen access to care, reduce waste, and promote financial stability across the system.

Our platform highlights six core policy priorities:

Fair Wage Reimbursement
Universal Nursing Assessment
Repeal of the LHCSA RFO
Integrated Home Care Ecosystem
Live‑In Care Clarity
Workforce Ecosystem

Our policy Agenda

What Has FAIR Been Up To?

The FAIR team has been actively engaged with Senate and Assembly lawmakers and their staff on the Health and Aging Committees, introducing the new Association and discussing its proposals for the budget season and Legislative Session.

These meetings have involved representatives and staff from the offices of Senators Jake Ashby, Samra Brouk, Kristen Gonzalez, Patrick Ryan, and Robert Ortt, as well as Assembly Members Jeff Dinowitz, Demond Meeks, and Phil Steck.

The FAIR Access Team was also present at the Home Care Show! We extend our gratitude to the offices of Senate Majority Leader Andrea Stewart-Cousins and Assembly Member Amy Paulin for sending representatives to join us for our live podcast.

Click here to view the recording.

A New Era for Home Care

Fri, 17 Oct 2025 19:06:37 GMT

FAIR Vision 2026

"IN A TIME MARKED BY LIMITED RESOURCES AND FIERCE COMPETITION, OUR MISSION IS TO ENSURE THAT THE NEEDS OF PROVIDERS AND PATIENTS ARE EFFECTIVELY ADDRESSED."

- Sasha Guillaume, FAIR President

The FAIR Access Initiative recognizes New York's urgent need to protect—rather than weaken—the home care sector within an overall challenging fiscal outlook.

While the community's needs are only increasing and there is a rising demand for more and better care, providers and payors face severe workforce shortages, increasing costs, and stagnant reimbursement.

Further reductions are expected and would only destabilize essential services and jeopardize the ability of seniors and people with disabilities to remain safely at home.

To address these systemic challenges, FAIR is working proactively with lawmakers and regulators to develop and advocate for innovative as well as cost-saving programs that will strengthen the entire home care ecosystem.

Our focus is on clear, specific action to stabilize our future.

Fair Compensation and Financial Equity

Tackling financial inequities faced by home care providers outside of NYC - specifically in Long Island, who are currently reimbursed $2 to $3 less per hour than those in other regions, which creates a detrimental two-tiered system. Addressing this disparity is crucial for the recruitment and retention of workers, ensuring stable access to care.
Requiring transparency by mandating managed care organizations (MCOs) to disclose their payment rate calculations to enhance oversight and ensure fairness for home care workers.

Developing Unified Systems to eliminate duplicative evaluations by Managed Long Term Care Plans, ensuring a single, consistent plan of care.
Creating a Continuum of Care by streamlining services and adopting a hybrid PACE model to both reduce redundancy and improve outcomes while saving costs.
Centralizing Aide Training through a unified system for tracking aide training hours to reduce redundancy and costs across the industry.

Systemic Efficiency and Quality

Eliminating the LHCSA RFO: Requesting the elimination of the current Licensed Home Care Services Agency Request for Offers.
Addressing the NHTD Cap: Raising concerns over the NHTD enrollment cap, which limits services to 9,400 individuals without establishing a waitlist, thereby restricting access to care.

Regulatory Reform and Access Preservation

FAIR's Legislative Agenda:

As we schedule meetings with the Division of Budget and the Governor's office, FAIR will discuss the following crucial priorities for the upcoming fiscal year: