Opinion: Aging with Dignity Means Getting Managed Long-Term Care Right – City Limits

“Funding for Managed Long-Term Care (MLTC), the Medicaid program that allows low-income seniors and people living with disabilities to receive care at home, is rewarding plans serving the healthiest populations while penalizing plans serving the most complex populations.”

In New York, we have made a promise. We’ve said that older adults should be able to age with dignity, in their homes, in their communities, surrounded by the people and places they love.

But as we finalize this year’s State budget, that promise is at risk. Funding for Managed Long-Term Care (MLTC), the Medicaid program that allows low-income seniors and people living with disabilities to receive care at home, is rewarding plans serving the healthiest populations while penalizing plans serving the most complex populations.

And when we get that wrong, our neighbors pay the price.

MLTC makes aging in place possible. It ensures that people who need the most support—those managing multiple chronic conditions, recovering from serious illness, or living with disabilities— can receive the care they need where they want to be, at home, instead of being pushed into a hospital or nursing facility.

As Chair of the Senate Aging Committee, I see every day how high the stakes are. Tens of thousands of older New Yorkers rely on these services to remain safely in their homes and connected to their communities. They are counting on us to get it right.

Through the State’s Master Plan for Aging, we committed to helping New Yorkers age in place, strengthening the caregiving workforce, improving coordination, and ensuring people can access care at home, where they need it most.

But a plan is only as strong as the system behind it. Right now, that system is not working for those with the greatest needs. 

Community-based nonprofit organizations like VNS Health are on the front lines of this work. They are embedded in the neighborhoods they serve, and care for our neighbors every day. VNS Health serves more than 150,000 New Yorkers each year, employs thousands of union home health aides and nurses, and supports more people with complex needs than any other MLTC plan in the state. 

In many cases, these are individuals who require daily care, and sometimes care around-the-clock, to remain safely at home. When funding does not match their needs, the consequences are immediate and real. 

But “take from the sick, give to the healthy” MLTC rates are costing VNS Health nearly $200 million and putting the vulnerable New Yorkers it cares for at risk. That is not consistent with our values.

It is why I introduced legislation to ensure that MLTC plans serving those with the greatest needs are adequately funded. But beyond any one bill, the responsibility before us is clear: The final State budget must include funding for VNS Health and make sure that MLTC plan financing reflects the needs of the people who have the greatest needs. 

We cannot say we support aging in place and allow the care that makes it possible to weaken. We cannot ask families to shoulder this burden alone, and we cannot overlook the very people who depend on us to honor our commitment.

That is the promise we have made. Now we must keep it. 

Cordell Cleare is a state senator representing Harlem the and chair of the State Senate’s Aging Committee.