News10NBC Investigates: NYS gives homecare aides a raise but insurance companies keep most of it

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ROCHESTER, N.Y. – News10NBC is investigating a problem with money that should be going to people who care for people with disabilities. Sometimes it’s their own children.

New York State approved a raise of $2.50 an hour for home healthcare workers but the state, the healthcare workers and the agencies that pay them, say some insurance companies are keeping most of it.

As a result agencies have canceled regular overtime hours. And that basically wipes out the raise.

Mary Mann and her husband Mark are the home healthcare workers for her daughter Claire. They routinely work 17 hours of overtime a week at their home in Brighton to take care of her.

But in March they got a letter from the Center for Disability Rights, the agency that pays them, concerning their hours and raises.

It said their overtime is done because “the state gave [the raise] to insurance companies without mandating that they pass it along” to the agencies.

With the end of OT, the Mann’s stand to lose more than $400 a week. There goes their raise.

“This increase was supposed to be for the homecare providers,” Mary Mann said. “And where is it going? The insurance companies.”

“I’m kind of angry with the state,” Mark Mann said. “Why wouldn’t they do something about this? Why are they letting this happen? They’ve got to be aware at this point.”

They are now. Dozens of homecare workers and the agencies that pay them rallied inside the State Capitol today.

Here’s how the money works. The state sends it to insurance companies with managed care programs. The insurance companies forward the money to agencies like Center for Disability Rights. The agencies pay the homecare workers. But the agencies and the state say the insurance companies are keeping most of the raises.

“And what agencies typically saw upstate was anywhere from 0 to .20 cents per hour with the insurance companies keeping the rest,” said Bryan O’Malley, executive director of CDPAAYNS, the consumer directed action of New York.

Brean: “So the solution would be for the state to tell the insurance companies – don’t hold onto this extra money.”

O’Malley: CDPAAYNS: “That goes a long way to solving this problem.”

One insurance company, icircle based in Webster, declined to comment.

MVP Health wrote, “It is aware of the fiscal change for home health workers and has worked with providers to pay for services at a level that is consistent with the funding increase and available guidance from New York State.  As a regional, not-for-profit health plan, MVP values a collaborative relationship with healthcare providers throughout our communities, and the important role they play in treating our members. We will continue to review and implement any new regulatory guidance on this matter consistent with New York State rules and requirements.”

Excellus BCBS did not provide a statement.

Fidelis didn’t either after we requested one Monday, but in an email we obtained to an agency in December, Fidelis wrote, “There should never be OT in the program.”

When the state passed the raises for homecare workers, the law did not include language on how the money should get to the workers.

State Senator Rachel May from Syracuse said this at the Capitol rally: “What’s been happening is even though we raised the wage by $2, the insurance companies were only giving .25 cents more or .50 cents more to the agencies that were having to pay that extra two dollars.”

May is sponsoring a law that would force insurance companies to pass the money through.

“We want the Department of Health to set minimum rates that have to be paid to the agencies that hire the workers,” she said.

That would get the money to the workers.

Brean: “Not the insurance companies?”
May: “That’s the idea.”

Click here to vote on Senator May’s bill. Look for “Do you support this bill?” on the right side of the web page.